Is surgery worth it at my age

General
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About a year ago I started with severe pulsitile tinnitus in my left ear. I went To my PCP, nothing, ENT, nothing and after Several CT scans w/wo contract and several MRI w/wo contrast, nothing showed up that would explain ES. I was at my cardiologist and he invited me to see another MD ( who is now my PCP.) She also wanted a second opinion from a different ENT. This doctor was very thorough. After speaking with his colleagues, he requested that I see an interventional radiologist, Dr. Nassar who is familiar with ES. He did a angiography and found a definite ES Jugular compression. It took 5 months of doctor to doctor but I got an answer. I am fortunate to live in an area where there are several excellent specialists who deal with this. The closest is Dr. Cognetti. I was looking at another nine month waiting when an unexpected opening came up and I saw him a couple of months ago. I couldn’t schedule any surgery because I had had a vitreal hemmorage and was looking at surgery for that. After the retinal surgery, I also found that I had a stage 3 prolapse that needed to be taken care of. We were supposed to go on an extended trip in September but we have since cancelled it. I will be getting back to Dr. Cognetti in the next few weeks if I decide to go through with the surgery. Both the retinal surgery and this surgery have taken much longer for me to recover from. I’m just not sure if I can handle another surgery right now.My biggest symptom is the tinnitus but I have other symptoms that may or may not be a part of ES. I have bouts of virtigo, brain fog and/or memory issues, balance difficulty, sometimes difficulties in swallowing or pain in my neck when I turn my head and look down. My neck is full of arthritis so it’s hard to say about pain but it is transient. Thank you.

My question is: : My main symptom is severe pulsitile tinnitus. I surgery worth it?

I copied the findings of the arteriogram as follows:

INJECTION, NECK VIEWS: No hemodynamically significant extracranial arterial stenosis per NASCET criteria. LEFT INTERNAL CAROTID ARTERY INJECTION, NEUTRAL, FLEXION, AND RIGHT ROTATIO N HEAD VIEWS: The left distal cervical, petrous, cavernous, and supraclino id segments of the left internal carotid artery are angiographically unremarkable . The left anterior and middle cerebral arteries are angiographic ally unremarkable. On the neutral projection, there is narrowing of the left
cervical		 internal jugular vein with prominence of the left condylar plexus. Upon asking the patient to flex, there was near complete occlusion of the venous outflow vein with markedly increased flow through the condylar/suboccipital plexus. Significant narrowing is also present in the cervical internal jugular vein when asking the patient rotated her head to the right. There is no evidence for arteriovenous shunting. No saccular intracranial aneurysm is identified. IMP RESS ION: IMPRESSION: No evidence of arteriovenous shunting, intracranial aneurysm, or hemodynamically significant intracranial
arterial stenosis.		 Narrowing of the left cervical internal jugular vein with prominence of the left condylar/suboccipital plexus. Upon asking the patient to flex, there was near complete occlusion of the venous outflow vein with markedly increased flow through the condylar/suboccipital plexus. Significant narrowing is also present in the cervical internal jugular vein when asking the patient rotated her head to the right. These findings are compatible with styloidogenic venous compression as a cause for left-sided pulsatile tinnitus. Of note, on physical examination, and in agreement with the’s radiographic findings, the patient reports complete resolution of pulsatile tenderness upon compression of the left internal jugular vein. Workstation:WR0112

Imaging

IR ULTRASOUND GUIDE VASCULAR ACCESS (Order: 1601932054) - 9/9/2025

Result History

IR ULTRASOUND GUIDE VASCULAR ACCESS (Order #1601932054) on 9/14/2025 - Order Result History Report
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When jugular vein compression is eased by having the styloid removed, pulsatile tinnitus does often resolve, but there’s no guarantee … It does sound as if you have quite a few other symptoms as well, personally for me I was able to control the nerve pain enough to live with it, but the vascular symptoms were too bad to live with- I had constant off balance feeling, dizziness, head and ear pressure, brain fog, and some other weird, scary feelings like I was falling, and sucking/ rolling feelings inside my head. Sometimes these symptoms can get worse; the body diverts blood through other veins (collateral veins), which swell and take some of the load, but many of us get to the point where they stop compensating and the symptoms worsen.
I’m not encouraging you to have a surgery if you’re not sure, but it’s worth considering that these symptoms are unlikely to get better and may worsen, and there can also be cognitive effects, there have been a couple of research papers posted recently which are worth considering:
AGHAYEV (2026) - Review: Jugular Vein Compresion and Dementia - Emerging Evidence - General / Research Papers - Living with Eagle
Peng et. al.–Surgical treatment for cognitive impairment caused by IJV stenosis: clinical study of C1 transverse process resection - General / Research Papers - Living with Eagle

I don’t know if this is helpful, but some members have mentioned this doctor, as he has a pulsatile tinnitus clinic at UCSF, although as yours is likely caused by styloid compression there might not be anything non-invasive which would help… :
Matthew Amans, MD, MS - Neuroradiology, Diagnostic Radiology | UCSF Health

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I have read some of his articles. Very interesting and informative. When people talk about visual disturbances and SJVC, what "disturbances are they talking about?

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It can be seeing double, or feeling like you’re moving when you’re not, pulsing vision, floaters or flashes, visual snow, temporary vision loss…If you use the search function to look up visual disturbances, there’s lots of mentions in previous discussions, here’s one to read:
Visual & proprioceptive disturbances - General - Living with Eagle

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Thanks, I need to talk with a former PT when I had my last bout with virtigo. He had seen some things but wasn’t familiar with VES until I told him what I had found out. Thanks for sharing. Still working on navigating this site.

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@bs9652 - Learning to navigate this site can be it’s own ordeal! Please let us know if you have questions. Much of today’s modern tech is not intuitive to me so I understand if you’re struggling with this. It’s taken me quite a number of years on here to learn to navigate it as well as I do. :sweat_smile:

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I had tried to copy and paste the results from the arteriogram into my profile but it didn’t come out so well.

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@bs9652 - If you don’t want to put it on the forum but want to share it with @Jules or me (@Isaiah_40_31) in a private message, you can do that by clicking on one of our names in the earlier part of this sentence. That will take you to a page where you can start a private message to one or both of us.

Alternatively you can try to upload it using the underlined up-arrow in the menu at that top of the dialogue box when you reply to this message vs dragging & dropping it into the text box.

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