Assessment of Objective Pulsatile Tinnitus in a Patient with Syringohydromyelia

Abstract

We examined a 38-year-old male with syringohydromyelia and concomitant symptoms suggestive of intracranial hypertension including unilateral low-frequency sensorineural hearing loss and objective pulsatile tinnitus. The tinnitus was heard by the authors (through a hearing aid stethoscope tube), measured objectively (with a probe microphone), measured subjectively (as minimum masking levels and with fixed frequency Bekesy), and altered by changes in ear canal pressure (subjectively reported and measured objectively with a probe microphone). The audiologic symptoms were likely associated with elevated cerebrospinal fluid pressure that traveled to the cochlea through the cochlear aqueduct. The tinnitus may have originated from pulsations of central vascular structures that traveled through the cochlear aqueduct or the endolymphatic duct. Hearing loss likely resulted from tinnitus masking or a stiffening of the cochlear partition or stapes footplate.

Tinnitus Loudness Tracking: A “Type V Békésy” Pattern Does Not Exist for Pseudotinnitus

“…Perhaps our findings owe in part to the inherent difficulty of performing tinnitus loudness tracking reliably (Steiger et al, 2007), including when tinnitus is perceived bilaterally (Young and Lowry, 1981), and among participants who are not perceiving tinnitus at the time of testing (George and Kemp, 1989). Evidence of this can be seen in sample data variability.…”

“…Tracking audiometry can be used to match tinnitus loudness in a manner similar to that described above for audiometric threshold tracking, that is, by matching tinnitus loudness to the intensity of sweep frequency tones or to fixed frequency tones (Young and Lowry, 1981;George and Kemp, 1989;Steiger et al, 2007). However, the reliability of such measures appears somewhat uncertain.…”

“…However, the reliability of such measures appears somewhat uncertain. Steiger et al (2007) tracked tinnitus loudness in a participant with objective pulsatile tinnitus that masked his audiometric thresholds. The participant's tinnitus loudness tracking matches were in rough agreement with his masked audiometric thresholds, suggesting the tinnitus loudness tracking was grossly reliable.…”