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Pulsatile tinnitus: imaging and differential diagnosis.

Erich Hofmann¹, Robert Behr, Tobias Neumann-Haefelin

¹Klinikum Fulda gAG, Department of Neuroradiology, Germany. ehofmann.raz@klinikum-fulda.de

Deutsches Arzteblatt International

|July 26, 2013

Summary

Pulsatile tinnitus often has a specific cause, unlike idiopathic tinnitus. A thorough history and physical exam guide imaging to identify the source of this hearing condition.

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Area of Science:

Otolaryngology
Neurology
Radiology

Background:

Pulsatile tinnitus typically has an identifiable cause, contrasting with idiopathic tinnitus.
Clinical practice often faces uncertainty regarding diagnostic findings and work-up strategies for pulsatile tinnitus.

Purpose of the Study:

To review the literature and evaluate a patient series to clarify the diagnostic approach for pulsatile tinnitus.
To categorize the causes of pulsatile tinnitus based on their origin (arterial, arteriovenous, venous).

Main Methods:

Selective literature review.
Evaluation of a clinical patient series.

Main Results:

Pulsatile tinnitus can stem from arterial (e.g., arteriosclerosis), arteriovenous (e.g., fistulae), or venous (e.g., intracranial hypertension) sources.
In the patient series, common causes included temporal bone tumors (16%), venous anomalies (14%), and vascular stenoses (9%).
Dural arteriovenous fistulae, inflammatory hyperemia, and intracranial hypertension each accounted for 8% of cases.

Conclusions:

Integrating clinical findings with imaging studies is crucial for diagnosing pulsatile tinnitus.
A detailed patient history and physical examination are fundamental for effective diagnostic imaging.