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Pulsatile tinnitus
Pulsatile tinnitus
What is pulsatile tinnitus?
Pulsatile tinnitus is the perception of a rhythmic noise, often described as a beating or whooshing sound, that is synchronised with the patient’s pulse. Unlike conventional tinnitus, which is generally constant and non-rhythmic, pulsatile tinnitus is often a sign of a vascular abnormality or a blood circulation problem near the ear.
Symptoms
Symptoms of pulsatile tinnitus include:
- A beating or pulsating sound in one or both ears.
- A sensation of sound that may increase with exercise or when the head is tilted, or decrease with gentle compression of certain parts of the neck.
- Sometimes accompanied by hearing loss, dizziness or ear pain.
Care
Imaging examinations
To identify the possible causes of pulsatile tinnitus, several imaging examinations are used:
- Brain MRI and magnetic resonance angiography (MRA): to visualise the blood vessels in the brain and neck and detect masses, vascular malformations or other structural abnormalities.
- Computed tomography angiography (CT angiography) and temporal bone CT scan: to assess vascular abnormalities.
- Doppler ultrasound: to examine blood flow in the cervical and intracranial vessels.
- Conventional angiography: sometimes necessary for a more detailed examination of the blood vessels.
Medical care pathway
Patients suffering from pulsatile tinnitus should consult several specialists, including:
- ENT specialist (otorhinolaryngologist): initial consultation to assess the symptoms and perform the first examinations.
- Radiologist: to perform and interpret the imaging examinations.
- Neurologist: if intracranial vascular abnormalities are suspected.
- Cardiologist: if a cardiovascular cause is suspected.
- Interventional neuroradiologist: for cases requiring an endovascular procedure, particularly venous sinus stenting.
Treatments
Treatment options for pulsatile tinnitus depend on the underlying cause:
- Medical treatment: for causes related to hypertension or metabolic abnormalities.
- Surgical or endovascular intervention: for arteriovenous malformations, glomus tumours or dural fistulas.
- Endovascular embolisation: to treat certain types of vascular malformations, particularly using a stent.
- Auditory therapies: such as hearing aids or white-noise generators to reduce the perception of tinnitus.
- Behavioural therapy: to help patients manage the stress and anxiety associated with pulsatile tinnitus.
The level of evidence for these treatments varies, with surgical and endovascular interventions often based on case reports and clinical series, whereas medical and behavioural treatments have more robust evidence for symptom management.
Multidisciplinary discussion
The management of pulsatile tinnitus often requires a multidisciplinary approach, involving regular discussions between ENT specialists, radiologists, interventional neuroradiologists, neurologists, cardiologists and neurosurgeons to determine the exact cause and choose the appropriate treatment.
Follow-up
Follow-up of patients with pulsatile tinnitus is crucial in order to:
- Monitor treatment effectiveness: particularly after surgical or endovascular intervention.
- Manage residual symptoms: with ongoing auditory or behavioural therapies.
- Control risk factors: such as hypertension or other underlying medical conditions.
Follow-up is provided by a multidisciplinary team to ensure comprehensive care and improve patients’ quality of life.
Associated services
Associated services