Evaluation Criteria, Diagnostic Criteria, Surgical Indications, and Establishment of Surgical Standards for "Cerebral Tinnitus Syndrome" Caused by Internal Jugular Vein Stenosis.

"Cerebral tinnitus," also known as "cranial tinnitus," is a condition where patients perceive intracranial sounds, often described as complex noises like machinery, thunder, or sirens, and may occur intermittently or persistently. Clinically, cerebral tinnitus is typically not an isolated symptom but manifests as "Cerebral Tinnitus Syndrome." In addition to cerebral tinnitus, patients frequently experience symptoms such as tinnitus with hearing loss, headaches and dizziness, head fullness or heaviness, dry eyes with blurred vision, neck and shoulder discomfort, sleep disturbances, anxiety, depression, and cognitive or memory decline.

A recent study published in the Journal of the American Medical Association: Neurology indicates that approximately 750 million people worldwide suffer from tinnitus. Due to the similarity between the symptoms of tinnitus and cerebral tinnitus, many tinnitus patients also experience cerebral tinnitus, making it difficult to distinguish between these symptoms accurately. Consequently, a substantial portion of the surveyed population may, in fact, be patients with "Cerebral Tinnitus Syndrome."

The fast-paced nature of modern life, coupled with increased stress from work and daily responsibilities, has contributed to the rising incidence of cerebral tinnitus, which has now become a common condition impacting quality of life and overall health in China. Unfortunately, effective treatments for "Cerebral Tinnitus Syndrome" remain unavailable. With limited public awareness about cerebral tinnitus, many patients seek medical help without success; conventional medications yield limited results, and patients often rely on anti-anxiety or antidepressant medications to alleviate symptoms, which severely impacts their and their families' lives and work.

Currently, the etiology of cerebral tinnitus remains unclear. Some studies suggest it may be related to alterations in blood flow within the dural sinuses or internal jugular veins (IJVs) caused by head and neck venous return obstruction or compensatory blood flow in collateral veins. Ji Xunming et al. proposed that cerebral tinnitus could result from stenosis of the cerebral or internal jugular veins, leading to impaired cerebral venous return, inadequate clearance of metabolic waste, and chronic metabolic alterations in brain cells. Specific causes may include cerebral venous thrombosis (CVT), cerebral venous sinus stenosis (CVSS), and internal jugular vein stenosis (IJVS). Unlike CVT and CVSS, IJVS is often caused by external compression, with the transverse process of the atlas and styloid process being primary contributors, affecting 40-70% of cases.

Currently, treatment approaches for cerebral tinnitus are primarily symptom-focused, lacking effective interventions targeting the underlying cause. Medications such as antidepressants and anxiolytics are mainly used to alleviate emotional symptoms, while steroids may temporarily reduce inflammatory responses associated with tinnitus, yet do not address IJVS-induced cerebral tinnitus. Audiotherapy and psychotherapy may improve psychological responses to symptoms but fail to treat the root cause. Surgical interventions may offer symptom relief in some cases with clear etiology; however, there are only a few case reports. Most available treatments are symptomatic rather than causal, underscoring the need for standardized diagnostic and treatment protocols for IJVS-induced cerebral tinnitus.