Pulsatile tinnitus

Background

Etiologies

• Arterial
  • Stenosis (9-18%): includes atherosclerotic plaques, the most common cause in the elderly, and fibromuscular dysplasia
  • Aneurysm (1-4%), particularly of the internal carotid artery
  • Anatomical variant (1-4%)
• Arteriovenous transition
  • Dural arteriovenous fistula (7-8%)
  • Direct arteriovenous fistula (2-3%)
  • Arteriovenous malformation (0-1%)
  • Vessel-rich tumour (5-15%)
  • Capillary hyperemia (3-8%)
• Venous
  • Intracranial hypertension (8-16%)
  • Anatomical variant (12-14%)
• Other
  • Semicircular canal dehiscence (0-5%)
  • Other (4-8%)
• Unknown (20-23%)

Clinical Manifestations

• May be subjective (only heard by patient) or objective (also heard by physician)