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Pulsatile Tinnitus: Differential Diagnosis and Utility of a Modified CTA Protocol
Catherine L Kennedy1, Allison P Lipsky2, Prashant Raghavan3
1Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, MN.
Objective:
This study examines the most common causes of pulsatile tinnitus (PT) found with a modified CTA (mCTA) protocol and analyzes the protocol's diagnostic success rate.
Study Design:
Retrospective cohort.
Setting:
A single academic institution.
Patients:
Adult patients presenting for evaluation of PT from 2011 to 2021 who underwent mCTA were included.
Intervention:
mCTA is a bone-windowed CT angiogram with delayed postcontrast image acquisition permitting both arterial and venous imaging.
Main Outcome Measure:
Demographics, audiometric data, imaging, and final diagnoses were analyzed. The patients were divided into 2 groups: no prior imaging (NPI) and prior imaging (PI). Top diagnoses were determined and rates of efficacy and failure of the mCTA protocol were compared.
Results:
One hundred nine patients were recommended to obtain mCTA, of which 22 were lost to follow-up before obtaining imaging. The remaining 87 patients were included in data analysis, 42 in the NPI group and 45 in the PI group. The most common etiology of PT was transverse sinus stenosis with sigmoid sinus wall anomalies, affecting 22 patients (25.3%). The mCTA protocol efficacy rate was 96.5% and failed to capture an important imaging diagnosis at a rate of 3.5%. There was no significant difference in efficacy between the NPI and PI groups.
Conclusions:
mCTA was found to be an effective initial diagnostic tool for all patients, regardless of prior imaging status. The most common etiology of PT was transverse sinus stenosis with sigmoid sinus wall anomalies.
