Objective(s) To compare the rates of anxiety and depression between patients with pulsatile (PT) and non‐pulsatile tinnitus (NPT), and their correlation with tinnitus severity. Methods A prospective cross‐sectional study of consecutive patients presenting either to the otolaryngology clinic for pulsatile (PT) and NPT or to a tertiary care tinnitus habituation program (THP) were administered the tinnitus handicap inventory (THI), 7‐item general anxiety disorder scale (GAD‐7), and 9‐item patient health questionnaire (PHQ‐9). Median scores between groups and correlation of scores within groups were calculated and compared. Results Median THI scores were significantly higher for THP and PT patients as compared with unselected NPT patients (58 and 44 vs. 20, p ≤ 0.001). Median GAD‐7 (10 vs. 2.5 and 2, p ≤ 0.001) and PHQ‐9 (7 vs. 4 and 4, p = 0.04) scores were highest in THP patients compared with PT and NPT. The strongest correlation between tinnitus handicap and psychiatric measures was seen in THP patients. Conclusion THP patients report higher levels of anxiety and depression compared with PT and other NPT patients. Tinnitus severity correlates more strongly with GAD‐7 and PHQ‐9 scores in THP patients compared with other patient groups. PT patients have a greater self‐perceived tinnitus handicap than the general cohort of NPT patients, statistically comparable to THP patients. Despite this, anxiety and depression are not more severe in patients with PT as they are in THP patients. Level of Evidence 2B Laryngoscope, 133:683–688, 2023

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Objective:To assess the frequency of radiographic features of elevated intracranial pressure (ICP) in patients with sigmoid sinus wall anomalies (SSWA) and compare to those in idiopathic intracranial hypertension (IIH) and spontaneous CSF (sCSF) leaks.Study Design:Retrospective review.Setting:Tertiary care center.Patients:110 patients - 62 SSWAs, 19 IIH, 29 sCSF leaks.Main Outcome Measures:Demographics, comorbidities and radiographic features by diagnosis.Results:Imaging findings indicative of elevated ICP were similar across all three groups, as were body mass index, hyperlipidemia and diabetes. On univariate analysis, sCSF leak patients were significantly older than SSWA (60 vs. 41 years, p < 0.001) and IIH (60 vs. 40 years, p < 0.001) patients. They had a greater prevalence of arachnoid granulations than SSWA (75.8% vs. 37.1%, p < 0.01) and tegmen dehiscence than both SSWA and IIH (93.1% vs. 75.8% vs. 57.8%, p = 0.01), though a lower prevalence of empty sella than SSWA (44.8% vs. 72.5%, p < 0.001). SSWAs were present in roughly 44.3% of IIH and sCSF leak patients, and IIH in roughly 15.8% of SSWA and sCSF leak patients. Age (OR = 1.1, p = 0.001), hypertension (OR = 8.3, p = 0.01) and empty sella (OR = 0.1, p = 0.01) were predictive of sCSF leaks compared to SSWAs on multivariate analysis.Conclusions:Many radiographic and clinical features of elevated ICP are found at similar rates among patients with SSWA, IIH and sCSF leaks, suggesting a common underlying process. SSWAs seem to present earlier along this spectrum of phenotypes, while sCSF leaks present later. Differences in age, metabolic syndrome and ICP may influence a patient's clinical presentation.

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