PULSATILE TINNITUS - CLINICAL AND ANGIOLOGICAL EVALUATION

Pulse-synchronous tinnitus (PT) is deemed rare, but may be the first s ymptom of a variety of causes. Between 1987 and 1990, we have studied 23 patients with objective (n = 14) or subjective (n = 9) PT. In 10 pa tients, PT was the sole complaint. Final diagnoses included dural (n = 9) or pial (n = 1) arteriovenous malformation, carotid-cavernous fist ula (n = 3), glomus tumor (n = 3), intracranial carotid stenosis (n = 2), complicated migraine (n = 1), subarachnoid hemorrhage associated w ith Marfan's syndrome (n = 1), benign intracranial hypertension (n = 1 ), and venous PT of unknown cause (n = 1). Doppler ultrasound revealed pertinent pathologic findings in 11 of 13 patients studied. Angiograp hy established the final diagnosis in 18 of 21 patients. Therapy reduc ed or abolished PT in 16 patients. Our findings indicate that unusual causes must be considered in the diagnosis of PT. Even in isolated or subjective PT, a staged diagnostic work-up including angiography shoul d be initated.