What is the treatment for venous hum?

Treatment of Venous Hum

Venous hum typically requires no specific treatment as it is a benign physiologic finding, but when symptomatic, compression or surgical ligation of the internal jugular vein may be indicated. 1

Understanding Venous Hum

Venous hum is a continuous murmur that results from turbulent blood flow in the jugular veins. It has the following characteristics:

• Best appreciated in the right supraclavicular fossa
• Can be obliterated by:
  • Movement of the chin toward the stethoscope
  • Digital pressure over the ipsilateral jugular vein 1
• Often a normal finding, especially during pregnancy

Diagnostic Approach

Before considering treatment, confirm the diagnosis:

1. Physical examination:

   • Auscultate in the right supraclavicular fossa
   • Perform maneuvers to temporarily obliterate the sound:
     • Apply gentle digital pressure over the jugular vein
     • Have patient turn head toward the stethoscope 1

2. Rule out pathological causes:

   • If pulsatile tinnitus is present, imaging may be warranted to exclude:
     • Vascular masses
     • Aberrant arterial or venous anatomy
     • Vascular malformations 1

Treatment Algorithm

1. For Asymptomatic Venous Hum

• No treatment required
• Reassurance that this is a benign physiologic finding

2. For Mildly Symptomatic Venous Hum

• Simple maneuvers to temporarily relieve symptoms:
  • Turning head toward the affected side
  • Gentle compression of the jugular vein
  • Position changes (avoid supine position if symptoms worsen in this position)

3. For Severely Symptomatic Venous Hum (causing tinnitus)

• Conservative measures first:

  • Compression therapy over the jugular vein (20-30 mmHg) 2
  • Position changes to reduce venous flow

• Surgical intervention for persistent, debilitating symptoms:

  • Ligation of the internal jugular vein has been shown to provide permanent symptomatic relief 3, 4
  • This approach should be reserved for cases where the venous hum causes significant reduction in quality of life

Evidence for Surgical Treatment

Several case reports demonstrate successful treatment of symptomatic venous hum with surgical intervention:

• Ligation of the internal jugular vein abolished a venous hum that had been present for 14 years in one patient 5
• A 28-year-old woman with pulsating tinnitus achieved permanent symptomatic relief through ligation of the right internal jugular vein 3
• Ligation of the internal jugular vein has been successful in treating venous hum tinnitus 4
• One case reported resolution of both audible tinnitus and sensorineural hearing loss after high ligation of the right internal jugular vein 6

Important Considerations

• Venous hum may occasionally be a sign of underlying pathology such as vena cava thrombosis 7
• In pregnant women, venous hum is often a normal finding that resolves after delivery 1
• Distinguish venous hum from other continuous murmurs like mammary souffle, which is heard over the engorged breast during pregnancy and can be obliterated with firm pressure on the stethoscope 1

Clinical Pitfalls to Avoid

1. Don't mistake venous hum for a pathological murmur requiring cardiac intervention
2. Avoid unnecessary imaging for asymptomatic venous hum
3. Don't rush to surgical intervention before attempting conservative measures
4. Remember that venous hum in pregnancy is typically benign and self-limiting

When symptomatic and significantly affecting quality of life, surgical ligation of the internal jugular vein should be considered as it has demonstrated effectiveness in multiple case reports.