Vertebro-vertebral fistula presenting as a pulsatile tinnitus

Area of Science:

• Neurology
• Otolaryngology
• Vascular Surgery

Background:

• Tinnitus affects 10-15% of adults, manifesting as perceived sound without external stimuli.
• Pulsatile tinnitus (PT), a less common form (4% of tinnitus cases), is typically synchronous with the heartbeat and often has an identifiable vascular cause.
• Subjective PT is audible only to the patient, while objective PT can be heard by an examiner.

Observation:

• A case of a man with no prior ear disease or head trauma presented with left-ear subjective pulsatile tinnitus.
• Magnetic Resonance Angiography (MR angiography) revealed a left vertebro-vertebral arteriovenous fistula as the underlying cause.

Findings:

• The arteriovenous fistula was successfully treated using endovascular embolization.
• The patient experienced significant symptomatic relief following the endovascular procedure.

Implications:

• This case underscores the importance of investigating vascular etiologies in subjective pulsatile tinnitus.
• Endovascular embolization presents a viable and effective treatment option for arteriovenous fistulas causing PT.
• Early diagnosis and targeted treatment can lead to substantial improvement in quality of life for patients with PT.