Objective tinnitus in association with an abnormal posterior condylar emissary vein

Objective, pulsatile tinnitus can often be related to an identifiable vascular abnormality. An unusual case of a massively enlarged posterior condylar emissary vein associated with pulsatile tinnitus in a young woman is reported. Initial evaluation of this patient with computed tomography revealed an enhancing mass near the posterior arch of the first cervical vertebra. An angiogram showed this to be large venous varix (posterior condylar emissary vein) arising from the distal sigmoid sinus. It drained down the neck, near the posterior arches of the cervical vertebrae. Slight digital pressure over the internal jugular vein effectively eliminated the tinnitus, presumably by altering flow dynamics through the condylar vein. The internal jugular vein was ligated, and this reduced the patient's tinnitus, which was no longer objectively audible. The anatomy of the posterior condylar emissary vein is discussed, and the general evaluation of a patient with objective, pulsatile tinnitus is reviewed.