Advances in the pathogenesis of pulsatile tinnitus induced by sigmoid sinus wall abnormalities: A narrative review

Pulsatile tinnitus (PT) is characterized by the perception of rhythmic sounds synchronized with the heartbeat, with sigmoid sinus wall abnormalities (SSWA) being the most common etiology. The generation and transmission of sound in SSWA-PT are closely related to abnormal hemodynamics, elevated intracranial pressure, and anatomical abnormalities of the sigmoid plate and temporal bone pneumatization. Despite extensive research, the exact pathophysiological mechanisms of SSWA-PT remain unclear, often leading to misdiagnosis and suboptimal treatment outcomes. This narrative review synthesizes studies on the underlying mechanisms of SSWA-PT, published between 2000 and 2025, and selected based on relevance from databases such as PubMed and Google Scholar. We included clinical and imaging studies related to SSWA-PT, emphasizing that its occurrence results from the interplay of multiple factors. The review also discusses existing issues and highlights potential directions for future research.