A Compartment-Based Approach for the Imaging Evaluation of Tinnitus

Abstract

SUMMARY:Tinnitus affects 10% of the US general population and is a common indication for imaging studies. We describe a sequential compartment-based diagnostic approach, which simplifies the interpretation of imaging studies in patients with tinnitus. The choice of the initial imaging technique depends on the type of tinnitus, associated symptoms, and examination findings. Familiarity with the pathophysiologic mechanisms of tinnitus and the imaging findings is a prerequisite for a tailored diagnostic approach by the radiologist.ABBREVIATIONS AV ϭ arteriovenous; AVF ϭ arteriovenous fistula; AVM ϭ arteriovenous malformation; CPA ϭ cerebellopontine angle; DSA ϭ digital subtraction angiography; IAC ϭ internal auditory canal; ICA ϭ internal carotid artery; IIH ϭ idiopathic intracranial hypertension; MD ϭ Mé niè re disease; NSAIDs ϭ nonsteroidal anti-inflammatory drugs; PSA ϭ persistent stapedial artery; TMJ ϭ temporomandibular joint.

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

“…The otology literature has described this dilemma, 18 with some advocating liberal use of angiography, while others advance MR imaging and CT-based approaches. 4,6 Clinical evaluation clarifies the presence of subjective "whooshing" 3. A, Coronal 3-mm-slab MIP from CTA in patient 3 with a right transverse sinus DAVF, predominantly supplied by right occipital, middle meningeal, and marginal tentorial branches; some supply from the left internal carotid is also seen, as described below. This case illustrates the "asymmetric jugular attenuation" sign, which is easily appreciated when the R and L IJVs are compared.…”

“…Accordingly, the ideal test would demonstrate high sensitivity for such clinically significant causes of PT. 4 A recent review of case series found structural/anatomic causes of PT in 44%-91% of cases. 9 Although a majority of patients may remain "idiopathic" even after extensive workup, the possibility of a morbid and/or treatable cause of PT, such as a DAVF, represents a common indication for imaging.…”

“…[1][2][3][4][5] Its causes are predominantly vascular, either arterial or, more commonly, venous. [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.…”

CT evaluation of sigmoid plate dehiscence causing pulsatile tinnitus

“…Unlike non-PT, PT can usually be found with potential causes [1]. CT arteriography/venography (CTA/V) is mostly recommended for PT patients with normal otoscopic findings, which allows assessment of arterial, venous and neoplastic causes with a single examination [2][3][4][5][6].…”

Temporal Bone Hyperpneumatization and Tinnitus: Clinico-Radiological Evaluation Using CT Scan

“…It is a common symptom affecting about 30% of the population worldwide (1). Temporal bone hyperpneumatization (TBHP) has been implicated as a possible etiological factor in the development of subjective tinnitus (ST) (2).…”