Differential Diagnosis for Pulsatile Tinnitus when Putting Pressure on Temporal Artery

• Single most likely diagnosis
  • Giant Cell Arteritis (GCA): This condition is characterized by inflammation of the medium and large arteries, including the temporal artery. Pulsatile tinnitus that changes with pressure on the temporal artery can be a symptom, along with headache, jaw claudication, and visual disturbances. The association with temporal artery pressure is a key clue.
• Other Likely diagnoses
  • Temporal Arteritis: Similar to GCA but more localized to the temporal artery. Symptoms can include tinnitus that is affected by pressure on the artery, along with localized pain and tenderness.
  • Carotid Artery Stenosis: Narrowing of the carotid artery can lead to pulsatile tinnitus, especially if the stenosis is significant enough to cause turbulent blood flow. Pressure on the temporal artery might indirectly affect blood flow or pressure in the carotid system, altering the perception of tinnitus.
  • Atherosclerosis: Generalized atherosclerosis affecting the arteries near the ear or the temporal artery itself could potentially cause pulsatile tinnitus that might seem to change with pressure on the temporal artery due to altered blood flow patterns.
• Do Not Miss diagnoses
  • Aneurysm or Arteriovenous Malformation (AVM): Although less common, an aneurysm or AVM in the vicinity of the temporal artery or affecting the blood vessels supplying the ear could cause pulsatile tinnitus. These conditions are critical to identify due to their potential for rupture or other complications.
  • Glomus Tumor: A rare tumor of the middle ear that can cause pulsatile tinnitus due to its vascular nature. It's essential to consider this diagnosis due to its potential impact on hearing and the need for early intervention.
• Rare diagnoses
  • Fibromuscular Dysplasia: A rare condition affecting the arteries, leading to stenosis, aneurysm, or dissection. It could potentially cause pulsatile tinnitus if it affects the arteries supplying the ear or the temporal artery itself.
  • Temporal Artery Aneurysm: A rare condition where an aneurysm forms on the temporal artery, which could cause tinnitus and other symptoms that might seem to change with pressure on the artery.
  • Otosclerosis: A condition affecting the bones of the middle ear, leading to hearing loss. In some cases, it might cause pulsatile tinnitus, although this is less common and the connection to temporal artery pressure would be indirect.