What is pulsatile tinnitus?

What is Pulsatile Tinnitus?

Pulsatile tinnitus is a type of tinnitus characterized by hearing internal noises without an external sound source. It is often perceived as pulsing, ringing, or intermittent sounds. Pulsatile tinnitus accounts for approximately 4% of all tinnitus cases.

Causes of Pulsatile Tinnitus:

venous pulsatile tinnitus:

One of the most common causes is venous pulsatile tinnitus, frequently heard as heartbeat-like pulses or intermittent sounds resembling flowing water or air. A primary cause includes:

Sigmoid Sinus Dehiscence: This occurs when the bone covering the sigmoid sinus—a vein located behind the middle ear that drains blood from the brain to the heart—erodes. Named “sigmoid” due to its “S”-shaped path, this condition is more common in middle-aged women and may be accompanied by hearing loss or vertigo in some cases.

Steps to Diagnose Pulsatile Tinnitus:

Accurate identification of the tinnitus type as a first step.

  • Investigation of the cause through:
  • Evaluation of factors such as obesity or thyroid hormone imbalances.
  • Imaging tests (CT scans or MRI) of the brain and veins to rule out:
    • Elevated intracranial fluid pressure.
    • Vascular abnormalities around the brain.

Treatment Options for Pulsatile Tinnitus:

After consultation between the patient and doctor, options include:

Non-Surgical Treatment:

  • Identifying the cause may suffice for some patients.
  • Weight loss if obesity is a factor.
  • Medications to reduce intracranial fluid pressure (if present).
  • Correction of thyroid hormone imbalances (if present).

Surgical Treatment:

If no other cause is identified, a simple surgical procedure to reconstruct the exposed area of the sigmoid sinus may be performed.

Outcomes:

    • Resolution of pulsatile tinnitus in 74% of cases.
    • Partial improvement in 14% of cases.
    • No improvement in 12% of cases.