Pulsatile Tinnitus as the Primary Symptom in IIH: A Distinct Clinical Entity

Area of Science:

• Neurology
• Otolaryngology
• Ophthalmology

Background:

• Idiopathic intracranial hypertension (IIH) is a condition characterized by increased intracranial pressure without a clear cause.
• Pulsatile tinnitus (PT) is a rhythmic sound heard in the ear, synchronous with the heartbeat, and can be a symptom of IIH.
• Understanding the clinical presentation of IIH, particularly when associated with PT, is essential for diagnosis and management.

Purpose of the Study:

• To compare the clinical characteristics of patients with IIH who present with pulsatile tinnitus (PT) to the Otolaryngology service versus those with IIH who present with more classical symptoms to non-otolaryngologists.
• To identify distinct features of IIH patients with PT.

Main Methods:

• A chart review identified patients diagnosed with PT and IIH using modified Friedman criteria.
• Two cohorts were established: Cohort 1 (PT as chief complaint to otology) and Cohort 2 (classical IIH symptoms to non-otolaryngologists, later evaluated for PT).
• Demographic data, symptoms (headache, visual disturbances), clinical findings (papilledema, CSF pressure), and imaging were analyzed.

Main Results:

• Forty female patients (20 per group) were analyzed.
• Cohort 1 (PT) patients were less likely to have visual symptoms (25% vs. 90%) or papilledema (40% vs. 85%) compared to Cohort 2.
• Cohort 1 patients had lower CSF opening pressure (29.2 vs. 35.1 mmHg) and similar headache prevalence, though headaches were milder.

Conclusions:

• Patients with IIH presenting with PT represent a distinct clinical entity.
• Awareness of this specific presentation is vital for clinicians to initiate appropriate management strategies for IIH and associated PT.