What is pulsatile tinnitus?

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.

Common causes

  • Dural arteriovenous fistula (DAVF) — most important vascular cause to exclude
  • Sigmoid sinus dehiscence or diverticulum
  • Jugular bulb abnormality
  • Idiopathic intracranial hypertension (IIH)
  • Carotid artery stenosis or fibromuscular dysplasia
  • Glomus tumour (paraganglioma)
  • Benign intracranial hypertension

Investigation

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

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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Next treatmentIdiopathic Intracranial Hypertension (IIH)