搏動(dòng)性耳鳴表現(xiàn)為耳內(nèi)呼呼狀、嗡嗡狀、咚咚狀的節(jié)律性噪聲，頻率多與心跳、脈搏一致，嚴(yán)重影響日常生活。與非搏動(dòng)性耳鳴經(jīng)常找不到病因不同，搏動(dòng)性耳鳴經(jīng)全面檢查后多可發(fā)現(xiàn)多種潛在相關(guān)異常。針對(duì)責(zé)任原因或最大權(quán)重因素治療后，噪聲可明顯好轉(zhuǎn)或完全消失。如何精準(zhǔn)判定責(zé)任原因或最大權(quán)重因素是決定療效的關(guān)鍵。

一、常見原因：

二、診療技術(shù)

1、顳骨雙期增強(qiáng)CT檢查

本中心創(chuàng)建的顳骨雙期增強(qiáng)CT檢查方案，通過單次檢查即可明確搏動(dòng)性耳鳴的絕大多數(shù)潛在原因。基于該檢查方案以及本中心對(duì)搏動(dòng)性耳鳴的認(rèn)知水平，將形態(tài)學(xué)潛在病因檢出率由44%提升至94%；對(duì)腦卒中風(fēng)險(xiǎn)高、發(fā)病率達(dá)18%的致鳴原因-硬腦膜動(dòng)靜脈瘺的檢出效能，由國際推薦方案的“difficult to assess”提高至靈敏度96%、特異度100%。該方案被寫入我國衛(wèi)生行業(yè)標(biāo)準(zhǔn)《CT檢查操作規(guī)程》。

2、超高分辨率CT檢查

本中心自主研制了分辨尺度達(dá)0.05毫米的（國際最高）的CT設(shè)備，對(duì)于搏動(dòng)性耳鳴骨質(zhì)病因的精確評(píng)估較其他高端CT設(shè)備具有顯著優(yōu)勢(shì)，包括骨壁裂缺、半規(guī)管裂、耳硬化癥等。

3、4D Flow MRI檢查

本中心優(yōu)化了4D Flow MRI檢查的靜脈竇成像方案，將致鳴因素從形態(tài)表征拓深至更根本的血流特性，包括血流速度、血流量、壓力梯度、渦流等，為明確導(dǎo)致搏動(dòng)性耳鳴的責(zé)任原因和部位提供了客觀證據(jù)。該方案被納入美國《耳鳴適用性標(biāo)準(zhǔn)》。

4、基于CT及4D Flow MRI的個(gè)體化致鳴作用模擬

本中心國際首次基于個(gè)體化真實(shí)形態(tài)及血流數(shù)據(jù)構(gòu)建了多物理場(chǎng)數(shù)值仿真模型，可用于規(guī)劃患者的個(gè)性化治療方案，并預(yù)測(cè)治療效果。該方案及相關(guān)結(jié)果受到國際權(quán)威專家的高度評(píng)價(jià)。

圖7.(a)超高分辨率CT設(shè)備；(b)超高分辨率CT顯示人體最小的骨頭-鐙骨；(c)高端螺旋CT顯示鐙骨

圖8.4D flow MR顯示與耳鳴相關(guān)的噴射狀血流與渦流

圖9.計(jì)算流體力學(xué)仿真模擬支架植入前后血流流線和切應(yīng)力變化

三、治療手段

1、骨壁重建術(shù)

骨壁重建術(shù)可用于治療血管周圍骨壁裂缺的患者。本中心是我國開展骨壁重建術(shù)起步最早的團(tuán)隊(duì)，手術(shù)技術(shù)成熟，行骨壁重建術(shù)的患者已知全球最多，整體有效率80%以上，且術(shù)后并發(fā)癥少，無重大不良反應(yīng)。

圖10.骨壁重建手術(shù)前后的術(shù)中圖像和CT圖像

2、支架植入術(shù)

支架植入術(shù)可用于治療橫竇狹窄的患者。對(duì)于橫竇狹窄的特發(fā)性顱高壓患者，支架植入術(shù)不僅可消除噪聲，更重要的是可以降低顱內(nèi)壓、改善視力、頭疼癥狀。本中心發(fā)現(xiàn)對(duì)于橫竇狹窄并骨壁裂缺、憩室形成的患者，僅針對(duì)橫竇狹窄進(jìn)行支架植入即可達(dá)到消除噪聲的效果，同時(shí)部分患者憩室可因骨壁再生而消除。

圖11.支架植入前后的橫竇形態(tài)改變以及乙狀竇憩室區(qū)骨質(zhì)再生改變

3、本中心可開展的其他治療方案

針對(duì)異位血管的血管結(jié)扎術(shù)，針對(duì)硬腦膜動(dòng)靜脈瘺/畸形的供血?jiǎng)用}栓塞術(shù)，針對(duì)富血供腫瘤的側(cè)顱底腫瘤切除術(shù)，針對(duì)耳硬化癥的人工鐙骨植入術(shù)，針對(duì)動(dòng)脈粥樣硬化的支架植入或內(nèi)膜剝脫術(shù)等。術(shù)者均為國內(nèi)行業(yè)內(nèi)頂尖專家，手術(shù)安全性及效果有較大保障。

四、研究方向

1、基于多源異構(gòu)因素的搏動(dòng)性耳鳴多因素協(xié)同致鳴機(jī)制

2、搏動(dòng)性耳鳴治療后復(fù)發(fā)機(jī)制

3、基于人工智能技術(shù)的搏動(dòng)性耳鳴精準(zhǔn)診療

五、階段性成果（近五年）

1. Xu, K., Qiu, X., Dai, C. ,et al (2024).Fluid-structure interaction study on the causes of mending material damage after sigmoid sinus wall reconstruction. Computer Methods and Programs in Biomedicine,245

2. Dai, C., Zhao, P., Wang, G. ,et al (2024).Hemodynamic assessments of unilateral pulsatile tinnitus with jugular bulb wall dehiscence using 4D flow magnetic resonance imaging. Quantitative Imaging in Medicine and Surgery,14(1) 684-697

3. Liu, Y., Ding, H., Qiu, X. ,et al (2024).Progresses in imaging researches of transverse sinus stenosis. Chinese Journal of Medical Imaging Technology,40(1) 121-124

4. Dai, C., Zhao, P., Ding, H. ,et al (2023).CT evaluation of unilateral pulsatile tinnitus with jugular bulb wall dehiscence. European Radiology,33(6) 4464-4471

5. Mu, Z., Zhuang, L., Zhao, P. ,et al (...) (2023).Multiphysics Interaction Analysis of the Therapeutic Effects of the Sigmoid Sinus Wall Reconstruction in Patients with Venous Pulsatile Tinnitus. Bioengineering,10(6)

6. Ding, H., Zhao, P., Lv, H. ,et al (2023).A new method for assessing transverse sinus stenosis with CT venography based on the venous trans-stenotic pressure gradient. Journal of NeuroInterventional Surgery,15(10) 1034-1038

7. Mu, Z., Li, X., Zhao, D. ,et al (2022).Hemodynamics study on the relationship between the sigmoid sinus wall dehiscence and the blood flow pattern of the transverse sinus and sigmoid sinus junction. Journal of Biomechanics,135

8. Li, D., Wang, G., Zeng, R. ,et al (2022).Analysis of Revision Surgery Following Surgical Reconstruction of the Sigmoid Sinus Wall in Patients with Pulsatile Tinnitus. Journal of International Advanced Otology,18(4) 358-364

9. Liu, L., Mu, Z., Kang, Y. ,et al (2022).Hemodynamic mechanism of pulsatile tinnitus caused by venous diverticulum treated with coil embolization. Computer Methods and Programs in Biomedicine,215

10. Qiu, X., Zhao, P., Mu, Z. ,et al (2022).Effects of Different Degrees of Extraluminal Compression on Hemodynamics in a Prominent Transverse-Sigmoid Sinus Junction. Frontiers in Human Neuroscience,16

11. Li, X., Xu, N., Dai, C. and 9 more (...) (2022).Altered Neurovascular Coupling in Unilateral Pulsatile Tinnitus. Frontiers in Neuroscience,15

12. Li, X., Xu, N., Meng, X. ,et al (2022).Dual-phase contrast-enhanced CT evaluation of dural arteriovenous fistula in patients with pulsatile tinnitus as an initial symptom. European Journal of Radiology,148

13. Hong, Z., Liu, X., Ding, H. ,et al (2022).Flow patterns in the venous sinus of pulsatile tinnitus patients with transverse sinus stenosis and underlying vortical flow as a causative factor. Computer Methods and Programs in Biomedicine,227

14. DIng, H., Zhao, P., Lv, H. ,et al (2021).Correlation between Trans-Stenotic Blood Flow Velocity Differences and the Cerebral Venous Pressure Gradient in Transverse Sinus Stenosis: A Prospective 4-Dimensional Flow Magnetic Resonance Imaging Study. Neurosurgery,89(4) 549-556

15. Zhao, P., Jiang, C., Lv, H. ,et al (2021).Why does unilateral pulsatile tinnitus occur in patients with idiopathic intracranial hypertension?. Neuroradiology,63(2) 209-216

16. Li, X., Qiu, X., Ding, H. ,et al (2021).Effects of different morphologic abnormalities on hemodynamics in patients with venous pulsatile tinnitus: A four-dimensional flow magnetic resonance imaging study. Journal of Magnetic Resonance Imaging,53(6) 1744-1751

17. Zhao, P., Ding, H., Lv, H. ,et al (2021).CT venography correlate of transverse sinus stenosis and venous transstenotic pressure gradient in unilateral pulsatile tinnitus patients with sigmoid sinus wall anomalies. European Radiology,31(5) 2896-2902

18. Mu, Z., Liu, L., Sun, Y. ,et al (2021).Multiphysics coupling numerical simulation of flow-diverting stents in the treatment of patients with pulsatile tinnitus. International Journal for Numerical Methods in Biomedical Engineering,37(12)

19. Mu, Z., Sun, Y., Li, X. ,et al (2021).Multiphysics coupling study on the effect of blood flow pulsation in patients with pulsatile tinnitus. Biocybernetics and Biomedical Engineering,41(3) 1197-1207

20. Qiu, X.-Y., Zhao, P.-F., Ding, H.-Y. ,et al (2021).Bone remodeling in sigmoid sinus diverticulum after stenting for transverse sinus stenosis in pulsatile tinnitus: A case report. World Journal of Clinical Cases,9(10) 2320-2325

21. Li, X., Zhao, P., Qiu, X. ,et al (2021).Altered cerebral blood flow in patients with unilateral venous pulsatile tinnitus: An arterial spin labeling study. British Journal of Radiology,94(1120)

22. Qiu, X., Zhao, P., Li, X. ,et al (2021).The Relationships Among Transverse Sinus Stenosis Measured by CT Venography, Venous Trans-stenotic Pressure Gradient and Intracranial Pressure in Patients With Unilateral Venous Pulsatile Tinnitus. Frontiers in Neuroscience,15

23. Zhao, P.-F., Zeng, R., Qiu, X.-Y. ,et al (2021).Diploic vein as a newly treatable cause of pulsatile tinnitus: A case report. World Journal of Clinical Cases,9(27) 8097-8103

24. Li, X., Xu, N., Meng, X. ,et al (2021).Transverse Sinus Stenosis in Venous Pulsatile Tinnitus Patients May Lead to Brain Perfusion and White Matter Changes. Frontiers in Neuroscience,15

25. Qiu, X., Zhao, P., Li, X. ,et al (2021).Effect of Emissary Vein on Hemodynamics of the Transverse- Sigmoid Sinus Junction. Frontiers in Human Neuroscience,15

26. Mu, Z., Qiu, X., Zhao, D. ,et al (2020).Hemodynamic study on the different therapeutic effects of SSWD resurfacing surgery on patients with pulsatile tinnitus. Computer Methods and Programs in Biomedicine,190

27. Huang, S., Li, X., Xue, X. ,et al (2020).Hemodynamic study of the therapeutic effects of the different degrees of sigmoid sinus diverticulum reconstruction on patients. Medical Engineering and Physics,868-15

28. Liu, Z., He, X., Du, R. ,et al (2020).Hemodynamic Changes in the Sigmoid Sinus of Patients with Pulsatile Tinnitus Induced by Sigmoid Sinus Wall Anomalies. Otology and Neurotology,41(2) e163-e167

29. Li, X., Zhao, P., Qiu, X. ,et al (2020).Lateralization Effects on Cerebral Blood Flow in Patients With Unilateral Pulsatile Tinnitus Measured With Arterial Spin Labeling. Frontiers in Human Neuroscience,14

30. Zheng, W., Peng, Z., Pengfei, Z. ,et al (2019).Long-term reactions to pulsatile tinnitus are marked by weakened short-range functional connectivity within a brain network in the right temporal lobe. Journal of Magnetic Resonance Imaging,49(6) 1629-1637

31. Ding, H., Zhao, P., Lv, H. ,et al (2019).Temporal bone contrast-enhanced high-resolution CT evaluation of pulsatile tinnitus after sigmoid sinus wall reconstruction. Acta Radiologica,60(1) 54-60

32. Lv, H., Zhao, P., Liu, Z. ,et al (...) (2018).Lateralization effects on functional connectivity of the auditory network in patients with unilateral pulsatile tinnitus as detected by functional MRI. Progress in Neuro-Psychopharmacology and Biological Psychiatry,81228-235

33. Liu, Y., Lv, H., Zhao, P. ,et al (2018).Neuroanatomical alterations in patients with early stage of unilateral pulsatile tinnitus: A voxel-based morphometry study. Neural Plasticity,2018

34.中國醫(yī)學(xué)影像技術(shù)研究會(huì)放射學(xué)分會(huì), 北京市醫(yī)學(xué)影像質(zhì)量控制和改進(jìn)中心. 耳鳴患者影像學(xué)檢查臨床適用性評(píng)價(jià)共識(shí)（2022版）. 中華醫(yī)學(xué)雜志, 2022, 102（27）:2067-2073.

35. 仇曉妤, 趙鵬飛, 丁賀宇等. 四維血流MRI技術(shù)在靜脈系統(tǒng)中的應(yīng)用進(jìn)展. 中華放射學(xué)雜志, 2022, 56（9）:1035-1038.

36. 趙鵬飛, 謝靜, 吳倩等. 基于10 μm級(jí)耳科專用CT的耳硬化癥影像特征分析. 中華醫(yī)學(xué)雜志, 2021, 101（47）:3885-3889.

37. 徐寧, 趙鵬飛, 丁賀宇等. 基于CT技術(shù)的顳骨解剖及耳科疾病應(yīng)用研究進(jìn)展. 中華醫(yī)學(xué)雜志社, 2021, 101（47）:3908-3911.

38. 代馳航, 趙鵬飛, 孟續(xù)續(xù)等. 基于CT血管造影分析無搏動(dòng)性耳鳴人群乙狀竇憩室形成的相關(guān)因素. 中華醫(yī)學(xué)雜志, 2020, 100（9）:702-705.

六、受試者參與

所有年齡、性別的受試者均可到本中心進(jìn)行臨床診療，臨床檢查和治療手段都是基于每一位受試者的臨床癥狀進(jìn)行個(gè)性化的選擇和制定。同時(shí)，本中心也開展了多項(xiàng)耳鳴相關(guān)的科研項(xiàng)目，每項(xiàng)研究都有特定的納入和排除標(biāo)準(zhǔn)。

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