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Diagnostic Approach to Pulsatile Tinnitus: A Narrative Review
Kazim H Narsinh1, Ferdinand Hui2, David Saloner1
1Department of Radiology & Biomedical Imaging, University of California, San Francisco.
JAMA Otolaryngology-- Head & Neck Surgery
|February 24, 2022
Summary
Pulsatile tinnitus, a symptom linked to stroke, requires careful diagnosis. Categorizing causes into structural, metabolic, and vascular groups aids in identifying serious conditions and guiding treatment.
Area of Science:
- Otolaryngology
- Neurology
- Vascular Medicine
Background:
- Pulsatile tinnitus affects millions and may indicate stroke.
- A definitive cause is found in over 70% of cases.
- Timely diagnosis is crucial for effective management.
Purpose of the Study:
- To propose a categorization system for pulsatile tinnitus causes.
- To facilitate practical evaluation, referral, and treatment.
Main Methods:
- Review and synthesis of existing literature on pulsatile tinnitus.
- Advocacy for a three-group classification: structural, metabolic, and vascular.
Main Results:
- Pulsatile tinnitus causes can be broadly categorized into structural (neoplasms, temporal bone abnormalities), metabolic (ototoxic medications, high cardiac output), and vascular (idiopathic intracranial hypertension, dural arteriovenous fistulas).
- This classification aids in identifying serious underlying conditions.
Conclusions:
- Categorizing pulsatile tinnitus causes ensures critical conditions are not missed.
- A structured approach improves patient care and specialist referral.
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