Pulsatile tinnitus in cerebrovascular arterial diseases

In a prospective study of 100 patients evaluated at the University of Wisconsin Stroke Program, we sought to document cases of incidental pulsatile tinnitus that could be ascribed to stenotic, occluded, ectatic, tortuous, or dissected craniocerebral arteries. Angiographic detail, magnetic resonance angiography, catheter-generated x-ray angiography, or both were necessary for inclusion into either Group 1 (n=29), those with pulsatile tinnitus, or Group 2 (n=71), those without pulsatile tinnitus. Patients did not appear to have head/neck tumors, aneurysms, arteriovenous malformations, transmitted cardiac murmurs, or venous etiologies for their tinnitus. Age, sex, and stroke risk factor profiles did not separate the two groups. Factors that were significantly more common in Group 1 included (1) severe, > or =70% stenosis through complete occlusion, internal carotid artery disease (59% for Group 1 v 21% for Group 2, P<.05); (2) severe, > or =50% stenosis through occlusion, vertebral or basilar disease (38% v 18%, P<.05); (3) tortuosity of at least one carotid, vertebral, or basilar artery (31% v 18%, P<.05); and (4) basilar artery dolichoectasia (14% v 0%, P=.006). We also noted when pulsatile tinnitus was either "objective" (11 of 100, 11%) or "subjective" (18 of 100, 18%), duration of tinnitus, transient versus permanent nature of tinnitus, and reasons seen in consultation by one of us.