EpistemisPulsatile tinnitus
Specialty: Otolaryngology.
Why it occurs
- Stenosis of the jugular vein or sigmoid sinus that generates turbulence in cerebral venous return
- Dural arteriovenous fistulas or malformations of the posterior cranial fossa
- Tumor of the glomus jugularis or glomus tympani (hypervascularized paragangliomas)
- Idiopathic intracranial hypertension with pulse transmission from the cerebrospinal fluid to the auditory system
- Atherosclerotic stenosis of the ipsilateral internal carotid artery causing turbulent flow near the petrous bone
Initial workup
Detailed auscultation of the skull, mastoid region and neck, tone audiometry with speech audiometry and tympanometry, CT angiography or brain and petrous MR angiography to visualize the arterial and venous vascular system, and lumbar puncture to measure opening pressure if idiopathic intracranial hypertension is suspected.
red flags
Presence of holocranial headache of increasing intensity associated with papilledema in the fundus of the eye, transient loss of vision or diplopia, lower cranial nerve palsy, cervical murmur audible to direct auscultation of the mastoid area, or history of recent head trauma of moderate or high intensity.
Standard management
- Treatment directed at the underlying cause. Acetazolamide is used in idiopathic intracranial hypertension. — 250-500 mg every 12 hours orally, with close monitoring of electrolytes and hydration by neurology or ophthalmology
- Antihypertensives if the origin is poorly controlled systemic arterial hypertension that exacerbates turbulent flow
- Beta blockers in low doses if there is idiopathic cardiovascular hyperdynamics assessed by cardiology.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 5
- Treatment options
- 3