Learning Perspectives in the Management of Sigmoid Sinus Diverticulum in the Absence of Pulsatile Tinnitus

Sigmoid sinus diverticulum (SSD) is an aberrant venous dilatation commonly associated with pulsatile tinnitus. However, an SSD without pulsatile tinnitus may be difficult to anticipate. Pre-operative computed tomography should be carefully reviewed for such vascular anomalies, with meticulous anticipation at surgery. SSD may pose a problem in proper visualization of the surgical field, and may put the surgeons in a dilemma on whether drilling can be continued safely. Right judgment, careful and patient drilling, and proper repair of the sinus plate in the event of inadvertent breach are the essential steps for a safe surgery. This clinical illustration describes the learning points in the management of a patient diagnosed with chronic otitis media with mixed hearing loss but without tinnitus, planned for tympanoplasty and cortical mastoidectomy, with an SSD discovered incidentally on imaging and encountered at surgery.