A rhythmic sound in the ear caused by a blood vessel problem — investigation and endovascular treatment.
Pulsatile tinnitus is a rhythmic sound in the ear that is synchronous with the heartbeat. Unlike conventional tinnitus (which produces a constant ringing or buzzing), pulsatile tinnitus is usually caused by a structural or vascular problem near the ear.
It is an important symptom that warrants investigation, as in a proportion of cases it indicates an underlying vascular condition such as a dural arteriovenous fistula, jugular bulb anomaly, or sigmoid sinus dehiscence.
Evaluation typically includes MRI and MR angiography/venography, CT of the temporal bones, and where a vascular cause is strongly suspected, catheter angiography (DSA). We co-ordinate investigations to minimise delay and provide a comprehensive assessment.
Treatment is directed at the underlying cause. For DAVFs, endovascular embolisation is highly effective. For sigmoid sinus anomalies, resurfacing procedures may be appropriate. Not all cases require intervention — thorough investigation and discussion is the first step.
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