Clin Exp Otorhinolaryngol.  2015 Mar;8(1):7-12. 10.3342/ceo.2015.8.1.7.

Single-Center 10-Year Experience in Treating Patients With Vascular Tinnitus: Diagnostic Approaches and Treatment Outcomes

• Bae SC
• Kim DK
• Yeo SW
• Park SY
• Park SN

• KMID: 1973481
• DOI: http://doi.org/10.3342/ceo.2015.8.1.7

Abstract

OBJECTIVES
Vascular tinnitus is the most common form of pulsatile tinnitus, particularly when the tinnitus corresponds with the pulse of patients. In this study, we reviewed the 10-year clinical data on vascular tinnitus of our tinnitus clinic to investigate the frequency of the underlying etiologies, to introduce a diagnostic protocol, and to evaluate the treatment outcomes.
METHODS
We retrospectively collected the data of 57 patients who were diagnosed as vascular tinnitus between April 2001 and December 2011. Careful history taking, otoscopy, thorough physical examinations, audiometry, laboratory tests, as well as radiologic examinations were performed according to our diagnostic protocol to find the origin of pulsatile tinnitus. Treatment options were individualized based on the specific etiology, and the outcomes were assessed using patient's subjective reports at the follow-up interviews.
RESULTS
High jugular bulb was the most common cause (47.4%) of vascular tinnitus, and venous hum was the next (17.5%). Dural arteriovenous fistula, intracranial aneurysm, atherosclerotic carotid artery disease, and hypertension were less common causes. Vascular tinnitus was alleviated in most patients after the appropriate treatment: surgical intervention, tinnitus retraining therapy, reassurance, and medications.
CONCLUSION
Vascular tinnitus can be successfully diagnosed by the regular use of the suggested protocol. Many patients with vascular tinnitus have treatable underlying etiologies. Treatment of those etiologies or at least counseling about the tinnitus itself can benefit the patients with troublesome vascular tinnitus.

Keyword

Aneurism; Arteriovenous fistula; Computed tomography; Pulsatile tinnitus; Magnetic resonance angiography

MeSH Terms

Arteriovenous Fistula
Audiometry
Carotid Artery Diseases
Central Nervous System Vascular Malformations
Counseling
Follow-Up Studies
Humans
Hypertension
Intracranial Aneurysm
Magnetic Resonance Angiography
Otoscopy
Physical Examination
Retrospective Studies
Tinnitus*

Figure

• 

  Fig. 1 Diagnostic algorithm for vascular tinnitus. TBCT, temporal bone computed tomography; TBMRI, temporal bone magnetic resonance imaging; HBP, hypertension; IJV, internal jugular vein; TN, tinnitus; MRA, magnetic resonance angiography; MRV, magnetic resonance venography; TCD, transcranial Doppler sonography; BIH, benign intracranial hypertension; ACAD, atherosclerotic carotid artery disease; AVF, arteriovenous fistula.

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