PULSATILE TINNITUS - A REVIEW OF 84 PATIENTS

Pulsatile tinnitus can be annoying for a patient and can also be the o nly clue to a potentially devastating and life-threatening disease. In order to understand its clinical spectrum and management better we an alysed the files of 84 patients seen at our institution over a 10-year period. Noninvasive techniques (ultra sound, computed tomography, mag netic resonance imaging) and angiography were employed as investigatio ns tailored to the individual patient. A vascular disorder [i.e. arter iovenous fistula, dissection of the internal carotid artery (ICA), fib romuscular dysplasia, aneurysm of the ICA and sinus thrombosis] was fo und in 36 patients (42%), most commonly a dural arteriovenous fistula or a carotid-cavernous sinus fistula. In 26 patients with a Vascular a bnormality, pulsatile tinnitus was the presenting symptom. In 12 patie nts (14%), non-vascular disorders such as glomus tumour or intracrania l hypertension with a variety of causes explained the tinnitus. We con clude that patients with pulsatile tinnitus should be investigated wit h noninvasive techniques. If these an negative or to clarify abnormal findings of noninvasive techniques selective angiography is needed for diagnosis and to guide treatment.