1Department of Otolaryngology, Pusan National University,Busan, South Korea/2Department of Diagnostic Radiology, Pusan National University, Busan, South Korea

A 33-years-old woman presented with right-sided pulsatile tinnitus and hearing disturbance was referred to our clinic for further evaluation and treatment. The tinnitus correlated with heart beat and was eliminated by gentle digital compression of the right jugular vein. HRCT of temporal bone revealed a large high jugular bulb with bony dehiscence in right middle ear. Transfemoral cerebral angiogram showed the right high jugular bulb, hypoplasia of the left transverse sinus, sigmoid sinus and internal jugular vein, and presence of occipital sinus. Left transverse sinus mainly drained into the occipital sinus and the occipital sinus drained into right sigmoid sinus only, just distal to jugular bulb. Considering the importance of right venous sinus and internal jugular vein in the intracranial venous drainage system of this patient, we decided to treat right high jugular bulb with the transvenous stent-supported coil embolization to preserve right venous sinus and internal jugular vein and this is the first report in the otologic field. Solitary stent placement across the base of the bulb, followed by embolization with coils, resulted in occlusion of the complete obstruction of the bulb protruding into the middle ear, patency of the venous drainage, and resolution of the tinnitus. The transvenous stentsupported embolization technique could be recommended as one of the treatments for high jugular bulb related to dominant sinus.