拍動性耳鳴を主訴とした硬膜動静脈瘻症例

Dural Arterio-Venous Fistula Presenting Pulsatile Tinnitus

　はじめに

　耳鳴は日常臨床でしばしば遭遇する訴えである。患者が高齢者で，しかも聴力の左右差が大きくない場合は加齢による感音難聴のためとされることが多い。しかし，耳鳴が拍動性であった場合，頭蓋内疾患などの器質的疾患の可能性もあり得る^1,2）。今回，右拍動性耳鳴を契機に発見された横-S状静脈洞部の硬膜動静脈瘻（dural arterio-venous fistula：以下，DAVF）例を経験したので報告する。

A 70-year-old woman presented with a chief complaint of right pulsatile tinnitus. The tinnitus was objectively audible as a bruit synchronous with heart beat at the right mastoid area through astethoscope. Since the tinnitus was supposed to be deriven from vascular disorder, angiography of the head was conducted and revealed the presence of the transverse-sigmoid dural arterio-venous fistula. The tinnitus was ceased after embolization of the influx arteries of the fistula. In many cases, tinnitus is derived from sensorineural hearing loss due to aging. However, in cases with pulsatile tinnitus, whether this tinnitus was audible objectively or not should be checked. If the tinnitus is audible, more precise examinations should be performed for detec tion of possible intracranial disorders.