Clinical Characteristics of Patients With Symptomatic Sigmoid Sinus Wall Anomalies.

OBJECTIVE: Evaluate geographic differences in clinical characteristics, including BMI, of patients with pulsatile tinnitus (PT) due to sigmoid sinus wall anomalies (SSWA). STUDY DESIGN: Systematic review and multi-institutional retrospective cohort study. SETTING: Three tertiary care centers, one each in the United States, China, and Korea. METHODS: For the systematic review, PubMed, Embase, and Scopus were queried for articles published through June 2025. The retrospective review included patients who underwent intervention for SSWA-associated PT from 2007 to 2025. RESULTS: Of 957 articles, 11 studies were included. BMI of US patients (n = 80) was 9.9 kg/m2 higher (p = 0.0001; CI 8.1-11.6) than East Asian patients (n = 261), but there was no difference compared to the national average BMI. The retrospective review included 111 United States, 151 Korean, and 206 Chinese patients. The BMI of US patients (33.61 kg/m2) was higher (p < .0001) and had greater variance (p < .0001) than that of Korean (25.22 kg/m2) and Chinese (23.21 kg/m2) patients. When compared to the national average BMI, US (p < .0001; ∆4.1 kg/m2, CI 2.5-5.7) and Korean (p < .0001; ∆1.8 kg/m2, CI 1.1-2.6) patients had higher mean BMI, but Chinese patients did not. US patients were more likely to be overweight or obese compared to Korean (odds ratio [OR] 3.17, p < .0001; CI 1.71-5.85) and Chinese (OR 5.75, p < .0001; CI 3.20-10.31) patients. Korean patients were 1.81 (p < .01, CI 1.18-2.79) times more likely than Chinese patients to be overweight or obese. CONCLUSIONS: BMI appears to be a more defining characteristic for American patients than East Asian patients with SSWA-associated PT. These findings have implications on the pathophysiology of SSWA and its relationship to IIH.