Pulsatile tinnitus: Audiologic and MR imaging diagnostic lssues

ABSTRACT

Pulsatile tinnitus often presents a diagnostic and management dilemma to the neurologist. Correct diagnosis is imperative because in the majority of cases, there is a treatable underlying etiology. In addition, failure to make proper diagnosis may be disastrous because in some patients, a life-threatening intracranial disease may be present. This study was carried out aiming to investigating the feasibility of differentiating the possible causes of pulsatile tinnitus, particularly in patients with normal otoscopy, using clinical, audiological and radiological, tools. 29 patients complaining of pulsatile tinnitus were evaluated by history taking, clinical examination, laboratory investigations, otoscopy, basic audiological evaluation, MRI for petrous bone and brain and MRA. Glomus jugulare tumor was diagnosed in 3 patients. Benign intracranial hypertension [BIH] was diagnosed in 4 patients. Intraventricular neoplasm in 2 patients. Internal carotid artery stenosis in one patient. Post-traumatic pseudoaneurysm in one patient. Scalp AVM in one patient. Temporal bone metastasis in one patient. Severe anemia in one patient and no identifiable cause [idiopathic] in 15 patients. A unilateral mild low frequency pseudosensorineural hearing loss was identified in 10 patients with normal otoscopy. Hearing loss was normalized after elimination of tinnitus by applying a light digital pressure over the ipsilateral internal jugular vein