pulsatile tinnitus

Pulsatile tinnitus is a specific type of tinnitus and refers to the perception of rhythmic noise, usually in time with the patient's heartbeat, in the absence of an external source, which is most commonly but not exclusively due to underlying vascular pathology.

Clinical presentation

Patients describe pulsing noise that sounds like rushing, flowing, or humming. Some recognize synchronization with their pulse and an increase in the sensation with physical activity or in a recumbent position .

  • subjective pulsatile tinnatus: heard only by the patient
  • objective pulastile tinnatus: heard by clinician on auscultation (neck or mastoid region)  

Pulsatile tinnitus of venous origin may be associated with a low-pitched hum on auscultation and suppression of symptoms with manual pressure on the ipsilateral internal jugular vein.

On otoscopy, neoplasms and vascular anomalies protruding into the middle ear cavity may be seen as a retrotympanic vascular mass.

Pathology

Numerous causes of pulsatile tinnitus are recognized, including:

Vascular
Hypervascular tumors
Non-vascular

Radiographic features

CT, MRI and digital subtraction angiography (DSA) are all useful, depending on the underlying cause. They provide complementary information in the evaluation of pulsatile tinnitus.

Given the wide range of entities that may present with pulsatile tinnitus, it is beyond the scope of this article to discuss each in turn. Rather, please refer to the articles for the specific entities above for individual imaging findings.