S205 – Neuroradiologic Assessment of Pulsatile Tinnitus

Abstract

Objectives To present a neuroradiographic imaging algorithm for patients presenting with pulsatile tinnitus. Methods This was a retrospective review of patients presenting to a tertiary care academic medical center from 1993 to 2007 with a chief complaint of pulsatile tinnitus. Clinical presentation and diagnostic imaging data were analyzed. Results Of the 108 patients identified, 93 patients had subjective pulsatile tinnitus and 15 patients presented with objective pulsatile tinnitus. In patients with subjective pulsatile tinnitus, 27/93 (29%) had positive radiologic findings, with 71% of cerebral angiogram studies and 57% of MR studies revealing anatomic abnormalities responsible for the pulsatile tinnitus. In patients with objective pulsatile tinnitus, 9/15 (60%) had positive radiologic findings, with 80% of cerebral angiogram studies and 57% of MR studies revealing anatomic abnormalities responsible for the pulsatile tinnitus. Magnetic resonance sensitivity in subjective and objective pulsatile tinnitus was 67% and 57% respectively. Conclusions Magnetic resonance is an excellent first-line diagnostic imaging modality in the assessment of pulsatile tinnitus. However, regardless of the subjective or objective nature of pulsatile tinnitus, cerebral angiography should be considered in patients with a negative MR and disabling pulsatile tinnitus.

Pulsatile Tinnitus

“…This nonpulsatile tinnitus is caused by a hearing malfunction (1). Less than 10% of tinnitus patients suffer from pulsatile tinnitus (2). If tinnitus can also be detected by a clinician, it is described as objective.…”

Our Experience in Pulsatile Tinnitus and a Normal Tympanic Membrane in 66 Patients

“…1 It is caused by turbulent blood flow generated by increased flow volume or vessel stenosis and may be of arterial or venous origin. 2 PT occurs in less than 10% of tinnitus patients 3 and is usually unilateral. 4 PT is therefore a relatively common otologic symptom and both expert consensus and general guidelines recommend that all patients with PT should be investigated.…”

“…4 PT is therefore a relatively common otologic symptom and both expert consensus and general guidelines recommend that all patients with PT should be investigated. 2,3 However, despite intensive assessment, no cause is found in up to 30% of cases and patients often end up on routine waiting lists for relevant imaging. 5 Life-threatening conditions (LTCs) can present with PT and these may have disastrous consequences, if not managed promptly.…”

Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up

“…All other auditory perceptions are considered non-pulsatile. Less than 10% of patients presenting with tinnitus have pulsatile tinnitus [2]. …”