Vertebro-vertebral fistula presenting as a pulsatile tinnitus

Abstract

Summary tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus, resulting in an estimated prevalence of 10% to 15% in adults. tinnitus may be classified as pulsatile (pt) or continuous (nonpt), and may be subjective (heard only by the patient) or objective (also audible to the examiner). pt is usually related to vascular causes and is pulse synchronous (coinciding with the patient's heartbeat). pt is much less common affecting approximately 4% of patients with tinnitus, but unlike non-pt, usually has a specific identifiable cause. We present a case of a man without previous otological disease or head trauma, with a left-ear subjective pt. Mr angiography detected a left vertebro-vertebral arteriovenous fistula, which was treated by endovascular embolisation with important symptomatic relief.

Dilated MMA sign in cDAVF and other arterial feeders on 3D TOF MRA

“…paraganglioma), and (b) nonvascular pathologies, including idiopathic intracranial hypertension and Paget's disease. 1,3 A cDAVF is the most frequent cause of objective pulsatile tinnitus in patients showing normal results in otoscopic examinations 4 and is also the condition that poses the greatest risk of mortality and morbidity without intervention, presenting with intracranial hemorrhage. 5 Van Dijk et al 6 reported that the rates of intracranial hemorrhage, nonhemorrhagic neurological deficits (NHNDs), and mortality for a non-treated or partially treated cDAVF were 35%, 30%, and 45%, respectively, over a mean follow-up period of 4.3 years in patients with cortical venous drainage.…”

“…paraganglioma), and (b) non-vascular pathologies, including idiopathic intracranial hypertension and Paget’s disease. 1 , 3 …”

Somatosound: A review with report of 9 cases with long-term follow-up

“…16,17 The plausible mechanisms of pulsatile tinnitus include: (1) changes in the laminar blood flow, or accelerated blood flow, resulting in audible local turbulence via the inner ear, or (2) normal blood flow sounds that are perceived more intensely due to increased bone conduction or sound conduction in the middle ear bypassing the masking effect of external sounds. 18,19 Therefore, the causes of pulsatile tinnitus can be divided into vascular and non-vascular. 20 Vascular causes are arterial, venous, or arteriovenous in origin.…”

“…Venous causes are malformations of jugular bulb (JB), transverse-sigmoid sinus aneurysm, venous hum, idiopathic intracranial hypertension, high flow through local emissary veins, or local venous stenosis. 12,13,[17][18][19]21 Arteriovenous causes include dural arteriovenous fistula (DAVF) and malformations, capillary hyperemia, and highly vascularized skull base tumors. 18,19 Non-vascular causes include neoplasms like a paraganglioma, osseous pathology, Paget's disease, endolymphatic sac tumor, and systemic disease, 17,18 for example, hematologic or endocrinologic disorders.…”

“…12,13,[17][18][19]21 Arteriovenous causes include dural arteriovenous fistula (DAVF) and malformations, capillary hyperemia, and highly vascularized skull base tumors. 18,19 Non-vascular causes include neoplasms like a paraganglioma, osseous pathology, Paget's disease, endolymphatic sac tumor, and systemic disease, 17,18 for example, hematologic or endocrinologic disorders.…”