Pulsatile tinnitus —a review of 84 patients

Abstract

Pulsatile tinnitus can be annoying for a patient and can also be the only clue to a potentially devastating and life-threatening disease. In order to understand its clinical spectrum and management better we analysed the files of 84 patients seen at our institution over a 10-year period. Noninvasive techniques (ultrasound, computed tomography, magnetic resonance imaging) and angiography were employed as investigations tailored to the individual patient. A vascular disorder [i.e. arteriovenous fistula, dissection of the internal carotid artery (ICA), fibromuscular dysplasia, aneurysm of the ICA and sinus thrombosis] was found in 36 patients (42%), most commonly a dural arteriovenous fistula or a carotid-cavernous sinus fistula. In 26 patients with a vascular abnormality, pulsatile tinnitus was the presenting symptom. In 12 patients (14%), nonvascular disorders such as glomus tumour or intracranial hypertension with a variety of causes explained the tinnitus. We conclude that patients with pulsatile tinnitus should be investigated with noninvasive techniques. If these are negative or to clarify abnormal findings of noninvasive techniques selective angiography is needed for diagnosis and to guide treatment.

Carotid Doppler Ultrasound Evaluation in Patients with Pulsatile Tinnitus

“…Daneshi et al [18] found atherosclerosis of the carotid artery as the cause of pulsatile tinnitus using color Doppler evaluation in 11.76 % of the patients. Waldvogel et al [12] reported ICA stenosis in 17 of 84 patients (20 %) and noted that atherosclerosis was the probable cause in 7 (%8) of these patients. Sismanis et al [9] reported atherosclerotic carotid artery disease (ACAD) as the cause in 16 % of the patients with pulsatile tinnitus.…”

“…Pulsatile tinnitus emanates from systemic diseases that disturb haemodynamics or local disorders in or in the vicinity of petrous bone [12]. Anemia, thyrotoxicosis, valvular heart disease, vascular lesions, neoplasms, intracranial hypertension belong to the group of diseases which result in pulsatile tinnitus [5,8].…”

“…Normally, the blood stream is laminar and noiseless in blood vessels. The disturbance of laminar flow and occurrence of turbulence may cause vessel wall vibration which result in audible sounds [11,12].…”

CT Angiography as a Screening Tool for Dural Arteriovenous Fistula in Patients with Pulsatile Tinnitus: Feasibility and Test Characteristics

“…[5][6][7][8][9] An extensive literature on imaging in PT describes a wide variation in the incidence of structural findings in patients with PT. 10,11 These discrepancies likely reflect heterogeneity in study populations, radiologist expertise, and imaging technique used in the evaluation. The utility of any first imaging test of PT is dependent on the sensitivity with which it detects treatable or worrisome causes of PT and allows appropriate management to be undertaken.…”

Ultrasonographic, CTI and MRI of Aberrant Internal Carotid Artery: Infrequent but Important to Know

“…12 Differential diagnosis should include a high dehiscent jugular bulb, a glomus jugulare tumor or glomus tympanicum tumor 5 or a pulsatile tinnitus because of a stenosis of the ICA. 13 We have shown that neurovascular ultrasound may lead the way to the diagnosis of an aberrant course of the ICA. Moreover, the differential diagnosis of this rare vascular anomaly should be kept in mind in the diagnosis of an occlusion in younger asymptomatic stroke or patients with TIA.…”