Differential Diagnosis for Unilateral Pulsatile Tinnitus in Pregnancy
- Single Most Likely Diagnosis
- Benign Intracranial Hypertension (BIH): Also known as idiopathic intracranial hypertension, this condition is more common in pregnant women, especially those who are obese. It can cause pulsatile tinnitus due to increased intracranial pressure. The symptoms often include headache and visual disturbances in addition to tinnitus.
- Other Likely Diagnoses
- Vascular Malformations or Fistulas: Conditions like arteriovenous malformations (AVMs) or dural arteriovenous fistulas (DAVFs) can cause pulsatile tinnitus by altering normal blood flow patterns. Pregnancy can sometimes exacerbate these conditions due to changes in blood volume and pressure.
- Middle Ear Problems: Conditions affecting the middle ear, such as a patulous Eustachian tube or middle ear effusion, can cause pulsatile tinnitus. These conditions might be more noticeable during pregnancy due to fluid retention and changes in blood volume.
- Do Not Miss Diagnoses
- Giant Cell Arteritis: Although less common, giant cell arteritis is a serious condition that can cause tinnitus among other symptoms like headache and visual disturbances. It's crucial to diagnose and treat promptly to prevent complications such as blindness.
- Venous Thrombosis: Venous sinus thrombosis can present with symptoms including headache, visual changes, and tinnitus. Given the increased risk of thrombosis during pregnancy, this diagnosis should be considered, especially if there are other risk factors for thrombosis.
- Rare Diagnoses
- Glomus Tumors: These are rare, benign tumors of the middle ear or jugular foramen that can cause pulsatile tinnitus due to their vascular nature. They are more likely to be considered if there's a mass visible on otoscopy or if imaging studies are performed.
- Otosclerosis: A condition affecting the bones of the middle ear, leading to hearing loss and sometimes tinnitus. While not typically pulsatile, in rare cases, it could be considered if other symptoms like conductive hearing loss are present.