Treatment For Vascular Loop Tinnitus
A 33-year-old woman began experiencing unilateral tinnitus four years prior. An MRI confirmed vascular loop contact between the VIIIth cranial nerve and her blood vessel system.
Vascular Loop Syndrome is a pulsatile or non-pulsatile tinnitus condition caused by compression of the anterior inferior cerebellar artery (AICA) in contact with a vein, often found in radiological studies as being common and leading to audiovestibular symptoms [1-7]. Studies have confirmed this vascular contact being frequent radiological findings which may contribute to audiovestibular symptoms [8, 9, 11].
Surgical Decompression
There is ongoing controversy as to whether vascular loops found in the AICA and inner ear can contribute to audiovestibular symptoms like hearing loss and tinnitus, but these loops are commonly present even among healthy individuals, and MRI offers high detection rates [5].
Hypothesis: Vascular loops may compress the VIIIth Cranial Nerve and lead to gliosis, edema and axonal degeneration which could ultimately result in audiovestibular symptoms. Numerous studies have attempted to link the presence and structural features of these vascular loops with unexplained tinnitus and hearing loss; however, results differ [7]. For instance, Gultekin et al.’s findings [8]. [2008] conducted an in-depth examination of AICA loops and their connections with CVN at CPA in patients with and without tinnitus; they could not detect any statistically significant variations between groups. Van der Steenstraten et al. [2007] examined 167 MRI scans of IAC and found no correlations between type and angulation of vascular loops with either unilateral SSNHL or tinnitus symptoms.
Another study was performed on a group of patients undergoing microvascular decompression (MVD) of the vestibulocochlear nerve for tinnitus and pulsatile vertigo, this involves removal of part or all of the lamina bone at the backside of spinal canal to give nerves more space by clearing away thickened ligaments and bone spurs called osteophytes; surgery can often be conducted on cervical, thoracic, or lumbar spine.
This study revealed that magnetic vibratory demodulation (MVD) treatments may produce significant improvements in both tinnitus and pulsatile tinnitus for some patients, though their authors cautioned this area of research could prove controversial since there remains little indication whether such results could be repeated with larger groups of people, and no proof that such procedures will also improve nonpulsatile tinnitus or sensorineural hearing loss; nevertheless, according to them this area warrants further exploration.
Medications
Studies of medications as treatments for vascular loop tinnitus have yet to provide conclusive answers, yet studies show some improvement when combined with tricyclic antidepressants and anticonvulsants. It’s thought these may work by inhibiting certain neurotransmitters that could contribute to nerve sensitivity – however their exact mechanism remains unknown. Symptoms can also be controlled using medications like benzodiazepines and tetracycline which are typically prescribed to relieve anxiety or depression – both conditions that contribute to symptoms of tinnitus symptoms; additionally they are used reduce migraine headaches or insomnia symptoms as well.
Vascular Loop Syndrome is a condition in which the 8th Cranial Nerve is compressed by blood vessels in close contact with it, leading to symptoms including tinnitus, vertigo and hearing loss. The intensity of symptoms varies between people; they can either be continuous or intermittent depending on cause such as trauma, tumor or vestibular Schwannoma.
Symptoms of Vascular Loop Syndrome can be difficult to pinpoint. An MRI may be ordered, while in other instances a diagnosis is made based on symptoms, history and examination alone. Common signs and symptoms may include tinnitus, intermittent vertigo, bilateral tinnitus in both ears, hearing loss and speech discrimination issues; furthermore if hyperventilation or changes in position trigger symptoms they could indicate Vascular Loop Syndrome.
Gorrie et al. [2010] conducted a study attempting to correlate vascular loop presence with unexplained asymmetric tinnitus symptoms; however, they concluded that it did not appear to have a significant impact on these individuals; no statistically significant association could be found between classification according to Chavda system classification of loops and any form of hearing loss or tinnitus symptoms in this group; nor could they find any correlations between size of loops and their locations within CPA/IAC/CVN contacts etc.
Hypnotherapy
An AICA loop of blood vessels may compress cranial nerves and cause tinnitus, vertigo and hearing loss. Most commonly these vascular loops appear in the CPA but they may also appear in the IAC. One case reported improvement following surgical decompression of an intrameatal vascular loop and unilateral pulsatile tinnitus due to surgical decompression; further investigation revealed a pericarotid venous plexus near its location which helped dull down its symptoms and dampened down its impact on his symptoms.
Studies have established a correlation between vascular loops and tinnitus; however, most of these patients also suffered from symptoms like trigeminal neuralgia or vestibular neuritis. MRI is frequently used to detect the presence of vascular loops but cannot definitively diagnose them as most are asymptomatic; furthermore there can be multiple lesions that cause audiovestibular symptoms; therefore it’s important to rule them all out with an exhaustive neurological workup including nystagmus examination, auditory brainstem evoked responses, video nystagmography, caloric testing etc.
Medication to relieve both pain and anxiety may be beneficial to some people living with vascular loop tinnitus. Such medications include NSAIDs, antidepressants and some types of selective serotonin reuptake inhibitors (SSRIs). Antidepressants have proven especially useful in relieving anxiety symptoms while improving sleep. Hypnosis may also help decrease intensity and intrusiveness; however its efficacy cannot rival cognitive behavioral therapy when treating tinnitus.
Psychological factors must also be taken into account, as they may contribute to tinnitus. People living with tinnitus often suffer from anxiety or depression which heightens perception and sensitivity to noise and other sounds, worsening perception and intensity further. Sometimes insomnia leads to further aggravation as sleep deprivation disrupts restful slumber, increasing loudness and perceived intensity further still. Therefore it would be advisable for such cases to consult a counselor who specializes in tinnitus is recommended.