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

To compare patients with idiopathic intracranial hypertension (IIH) who present with pulsatile tinnitus (PT) to the Otolaryngology service with those with IIH who present with more classical symptoms to non-otolaryngologists.

Chart query confirmed all patients diagnosed with PT and IIH (by modified Friedman criteria). Cohort 1: Those who presented with PT as their chief complaint were evaluated by one of the otology team members, referred to neuro-ophthalmology, and subsequently diagnosed with IIH. Cohort 2: Those who presented initially with headaches and/or visual abnormalities to a nonotolaryngologist where they were diagnosed with IIH syndrome and subsequently referred to and evaluated by an otologist for associated PT. Demographic data recorded included age, sex, and BMI. Analyzed symptoms included the presence of headache and visual disturbances. Clinical findings such as papilledema and cerebrospinal fluid (CSF) pressure measurements and imaging findings were also examined.

Forty (20 in each group) consecutive patients were included for analysis. All were female. Patients in Cohort 1 were statistically less likely to have visual symptoms (25% vs. 90%, p < 0.001) or papilledema (40% vs. 85%, p < 0.003). There was no difference in headache prevalence, though those in Cohort 1 were more likely to be mild. CSF opening pressure was lower in patients presenting with PT (29.2 ± 6.39 vs. 35.1 ± 10.8, p = 0.04).

Patients with IIH presenting with PT are a distinct entity from those with classic IIH. Clinicians must be aware so that appropriate management can be initiated.