Differential Diagnosis for Whooshing Sound in the Head

The patient's description of a whooshing sound in her head, likened to a yawn inside her head, suggests a variety of potential diagnoses. These can be categorized based on their likelihood and the urgency of their potential impact on the patient's health.

• Single Most Likely Diagnosis

  • Benign Tinnitus or Pulsatile Tinnitus: This condition is characterized by the perception of noise or ringing in the ears when no external sound is present. The description of a whooshing sound could be a variant of tinnitus, possibly related to vascular or muscular issues within the ear or head. It's a common condition and often benign, but it can significantly affect the patient's quality of life.

• Other Likely Diagnoses

  • Middle Ear Myoclonus: This is a condition where the muscles in the middle ear contract, leading to a clicking or whooshing sound. It's relatively rare but could fit the patient's description, especially if the sound is intermittent and associated with other middle ear issues.
  • Eustachian Tube Dysfunction: The Eustachian tube connects the middle ear to the back of the nose and throat. Dysfunction of this tube can lead to a variety of sounds, including whooshing, due to abnormal opening and closing of the tube.
  • Palatal Myoclonus: Similar to middle ear myoclonus, this involves the muscles of the palate and can cause clicking or other sounds that might be perceived as whooshing.

• Do Not Miss Diagnoses

  • Vascular Malformations or Aneurysms: Although less likely, it's crucial not to miss conditions like arteriovenous malformations (AVMs) or aneurysms, which could cause abnormal sounds due to turbulent blood flow. These conditions can be life-threatening if they rupture.
  • Carotid Stenosis or Dissection: Narrowing or tearing of the carotid artery can lead to abnormal sounds heard in the head, including whooshing, due to altered blood flow. These conditions require urgent medical attention to prevent stroke.
  • Glomus Tumor: A rare tumor of the middle ear that can cause pulsatile tinnitus due to its vascular nature. Early detection is crucial for effective treatment.

• Rare Diagnoses

  • Patulous Eustachian Tube: A rare condition where the Eustachian tube remains open, leading to autophony (hearing one's own internal sounds unusually loudly) and potentially a whooshing sound.
  • Superior Semicircular Canal Dehiscence: A rare condition of the inner ear where there's an abnormal opening in the bone overlying the superior semicircular canal, leading to a variety of auditory symptoms, including hearing internal sounds like breathing or heartbeat abnormally loudly.

Each of these diagnoses has different implications for the patient's health and requires a tailored approach to diagnosis and treatment. A thorough medical history, physical examination, and potentially further diagnostic tests (like imaging studies or audiologic evaluations) are necessary to determine the underlying cause of the patient's symptoms.