Pulsatile Tinnitus

Abstract

Pulsatile tinnitus (PT) is characterized by an auditory perception of pulse-synchronous sound. An alteration in the vascular hemodynamics causing turbulent flow, a vibration of a dehiscent vascular wall, or third window lesions are potential mechanisms of PT. Vascular PT can be subdivided into arterial, arteriovenous, and venous lesions. When the patient complains of psychoacoustic characteristics of PT, detailed physical examination and audiological evaluation complemented by etiology-targeted laboratory tests can provide diagnostic clues. Moreover, radiological evaluations such as brain magnetic resonance imaging (MRI) with angiography, temporal bone high-resolution computed tomography (CT), Doppler ultrasonography, and classical transfemoral cerebral angiography are recommended. Of various pathologies causing PT, dehiscence or diverticulum of the sigmoid sinus or jugular bulb is the most common cause that can be cured by surgical or interventional treatments. In addition, benign intracranial hypertension (BIH) is a common cause of PT. Although 15-50% of patients present with no definite diagnosis even after a meticulous diagnostic workup, the identification of the causal vascular pathology is vital for the optimal treatment of PT because successful surgical or interventional management is available in many cases.