Pulsatile and nonpulsatile tinnitus: A systemic approach

https://doi.org/10.1016/S0887-2171(01)90010-1Get rights and content

Abstract

Tinnitus is an annoying symptom that affects approximately 10% of the population. Unfortunately, in more than 60% of patients, even an extensive workup may not lead to diagnosis, partly because of the diverse causes of the symptom. The imaging protocol study should therefore be adapted to the history of the patient, and each imaging study should underline which etiologies it may exclude. Imaging studies should only be performed after a careful clinical examination and otoscopy. Some characteristic clinical findings are suggestive of such etiologies as pulsed synchronous tinnitus or positional tinnitus, varying with the venous pressure. History of associated neurological deficits, nerve palsies, trauma, ischemic attacks, and visual disturbance (in overweight women) may modify the imaging protocol. Study of the brain and the cervical vessels should always be included to rule out a benign intracranial hypertension. Path and size of the internal carotid artery should be systematically described with regard to the size of the jugular vein and presence of emissary veins. Objective pulsatile tinnitus and tinnitus in children always need a careful imaging study.

References (29)

  • E Kentala et al.

    Clinical picture of vestibular schwannoma

    Auris Nasus Larynx

    (2001)
  • A Sismanis

    Pulsatile tinnitus

    A 15-Year Experience

    American J Otol

    (1998)
  • JL Weismann

    Imaging of a tinnitus: A review

    Radiology

    (2000)
  • RR Dietz et al.

    MR imaging and MR angiography in the evaluation of pulsatile tinnitus

    AJNR Am J Neuroradiol

    (1998)
  • R Silbergleit et al.

    The persistent stapedial artery

    AJNR Am J Neuroradiol

    (2000)
  • HR Hansberger et al.

    Temporal bone vascular anatomy, anomalies and diseases emphasizing the clinical radiological problem of pulsatile tinnitus

  • J Maurer et al.

    Vascular origin of cerebellopontine angle syndrome

    HNO

    (2000)
  • KS Caldemeyers et al.

    The jugular foramen: A review of anatomy, masses and imaging characteristics

    Radiographics

    (1997)
  • M Tisch et al.

    Exposed superior bulb of the internal jugular vein

    Differential diagnosis in hearing loss diagnosis with pulse synchronous tinnitus

    HNO

    (1998)
  • RA Jahrsdoerfer et al.

    Endolymphatic duct obstruction from a jugular bulb diverticulum

    Ann Otol Rhinol Laryngol

    (1981)
  • DG Pappas et al.

    Petrous jugular malposition (diverticulum)

    Otolaryngol Head Neck Surg

    (1993)
  • RA Beyer et al.

    High jugular bulb and high carotid canal first observed as intracranial bruit

    Arch Neurol

    (1983)
  • V Couloignier et al.

    Surgical treatment of the high jugular bulb in patients with Ménière's disease and pulsatile tinnitus

    Eur Arch Otorhinolaryngol

    (1999)
  • JK DeMarco et al.

    Dural arteriovenous fistulas: Evaluation with MR imaging

    Radiology

    (1990)
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