Supervisors info:
Θωμάς Νικολόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Παύλος Μαραγκουδάκης, Επίκουρος Καθήγητης, Ιατρική Σχολή, ΕΚΠΑ
Αλέξανδρος Δελίδης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Pulsatile tinnitus is a special kind of tinnitus, which is noncontinuous, sometimes correlated with the patient’s arterial pulse or not. It is originated by non-hearing organs. Sounds that are produced into the body are heard by the acoustic apparatus. Pulsatile tinnitus is not correlated with disorders of the hearing system. It is usually caused by vascular anomalies (arterial etiologies, venous etiologies, arteriovenous etiologies).
However, pulsatile tinnitus may be caused by nonvascular etiologies.. There are also, normal anatomical variants that are presented with pulsatile tinnitus. In these cases, pulsatile tinnitus may subside by itself.
Diagnostic work-up of the pulsatile tinnitus is necessary because it may indicate the presence of a life-threatening condition. A careful and full examination of the patient must be done to define the etiology that produces the pulsatile tinnitus. Efforts must be done to reassure the patient, but not to underestimate serious illnesses that may cause neurological complications and death.
In this study, all the etiologies that are connected with pulsatile tinnitus were searched in the international bibliography as well as the way of their testing. All the anomalies that cause pulsatile tinnitus were presented as well as the responsible mechanism for them. These pathological situations were divided into two big categories: 1) the vascular etiologies that cause pulsatile tinnitus and 2) the non-vascular anomalies that provoke the presence of pulsatile tinnitus.
The vascular etiologies include arterial, venous or arteriovenous etiologies and conditions of high cardiac output.
The arterial causes include arteriosclerosis of the carotid artery, aneurysm of the internal carotid artery, abnormal course of the carotid artery, persistent trigeminal artery and stapedial artery, fibromuscular dysplasia of vessels, vascular loops, hemangiomas of the internal auditory canal and the temporal bone, pathologies of the occipital and subclavicular artery as well as high cardiac output conditions.
Venous causes that are connected with pulsatile tinnitus include idiopathic endocranial hypertension, arteriovenous malformations, arteriovenous dural fistulas, dural stenosis, diverticulum/deficit of the sigmoid sinus, anomalies of the jugular bulb, venous obstruction.
The non-vascular etiologies include myoclonus of the middle ear muscles, palatal myoclonus, dysfunction of the eustachian tube, neoplasms of the skull base and the temporal bone (paragangliomas), disorders of the temporomandibular joint and bone disorders, like otosclerosis, Paget’s disease.
There is also a special type of pulsatile tinnitus, called somatosensory pulsatile tinnitus, that is aggravated or modified with special movements of the body.
To conclude, pulsatile tinnitus is a noncontinuous type of tinnitus that sometimes needs multidisciplinary approach, in order to define the etiologies that are connected with it. ENT doctors must use a wide array of strategies in order to find the aetiology, reduce the severity of tinnitus and improve the patient’s quality of life.
