脑静脉流出障碍中的耳鸣及类耳鸣症状：一项批判性综述

文献信息

中文摘要

与颈内静脉流出障碍相关的静脉搏动性耳鸣及类耳鸣症状是一个新兴的临床话题，具有特殊的诊断和管理挑战。我们通过检索PubMed、Web of Science和Google Scholar中英文文献进行了一项叙述性综述。该综述聚焦于截至2026年2月发表的研究，这些研究涉及静脉搏动性耳鸣、颈内静脉狭窄或受压、脑静脉流出障碍、影像学与血流动力学评估以及管理策略。本综述总结了当前关于血管解剖、临床表现、病理生理机制、影像学评估和治疗的证据。结构性静脉异常和外部压迫可能产生血流紊乱和局部血管声音，尤其是在典型静脉搏动性耳鸣中；而静脉淤血、颅内压调节异常、脑灌注改变和中枢听觉可塑性仍是其他类耳鸣症状的候选机制。MRI/MRV、CTV/CTA和多普勒超声提供互补的解剖学和血流动力学信息。有创血管造影保留用于特定患者，当压力梯度评估具有临床相关性时加做静脉测压。管理选择包括保守治疗、颅内压管理、血管内治疗、手术减压和支持性耳鸣治疗。然而，当前证据主要来自经过选择的回顾性队列和小型病例系列，并未确定IJVOD在未经选择的静脉搏动性耳鸣患者中的患病率或因果贡献。需要标准化术语、经过验证的诊断标准、改进的患者选择以及前瞻性多中心研究，以提高诊断信心并实现对长期结局的可靠评估。

英文摘要

Venous pulsatile tinnitus and tinnitus-like symptoms associated with internal jugular venous outflow disturbance represent an emerging clinical topic with specific diagnostic and management challenges. A narrative review was conducted using English-language literature identified through searches of PubMed, Web of Science, and Google Scholar. The review focused on studies published through February 2026 that addressed venous pulsatile tinnitus, internal jugular vein stenosis or compression, cerebral venous outflow disturbance, imaging and hemodynamic assessment, and management strategies. This review summarizes current evidence on vascular anatomy, clinical presentation, pathophysiological mechanisms, imaging evaluation, and treatment. Structural venous abnormalities and external compression may produce disturbed flow and local vascular sound, particularly in classical venous pulsatile tinnitus, whereas venous congestion, intracranial pressure dysregulation, altered cerebral perfusion, and central auditory plasticity remain proposed mechanisms for other tinnitus-like symptoms. MRI/MRV, CTV/CTA, and Doppler ultrasonography provide complementary anatomical and hemodynamic information. Invasive angiography is reserved for selected patients, with venous manometry added when pressure-gradient assessment is clinically relevant. Management options include conservative care, intracranial pressure management, endovascular treatment, surgical decompression, and supportive tinnitus therapy. However, current evidence is derived mainly from selected retrospective cohorts and small case series and does not establish the prevalence or causal contribution of IJVOD in unselected patients with venous pulsatile tinnitus. Standardized terminology, validated diagnostic criteria, improved patient selection, and prospective multicenter studies are required to enhance diagnostic confidence and enable robust assessment of long-term outcomes.