Algorithm for evaluation of pulsatile tinnitus

Conclusions. Pulsatile tinnitus requires a careful physical examination and evaluation with selected imaging techniques to identify the origin of the symptoms. Objective. To evaluate the incidence of identifiable anomalies in patients with pulsatile tinnitus. Subjects and methods. This was a retrospective chart review undertaken in a tertiary care center. Patients seen in the outpatient otolaryngology clinic with the chief complaint of pulsatile tinnitus were evaluated by physical examination and imaging including CT angiography. The outcome measure was the incidence of identifiable abnormalities on imaging studies. Results. Fifty-four patients were seen between January 2002 and June 2007 with the chief complaint of constant pulsatile tinnitus, excluding those with chemodectomas. On the basis of physical examination and imaging, 14 were considered arterial, 23 venous, and 15 were indeterminate in origin. Among patients with venous tinnitus, sigmoid sinus diverticulum was the most common finding. Among patients with arterial tinnitus, carotid atherosclerotic disease was the most common. One patient had erosion of the cochlea by the carotid artery. Non-vascular entities identified include superior semicircular canal dehiscence and benign intracranial hypertension.