Differential Diagnosis for Pulsatile Tinnitus and Hyperacusis
Single Most Likely Diagnosis
- Middle Ear Myoclonus: This condition involves involuntary contractions of the middle ear muscles, which can cause pulsatile tinnitus and hyperacusis. It is a relatively common cause of these symptoms and often responds well to treatment with botulinum toxin injections or other medications.
Other Likely Diagnoses
- Patulous Eustachian Tube (PET): A condition where the Eustachian tube remains open, leading to autophony (hearing one's own internal sounds) and potentially pulsatile tinnitus and hyperacusis. It can be caused by weight loss, nasal decongestants, or other factors.
- Sigmoid Sinus Diverticulum or Dehiscence: An abnormality in the sigmoid sinus, which can cause pulsatile tinnitus due to the proximity of the sinus to the middle ear structures.
- Benign Intracranial Hypertension (BIH): Also known as idiopathic intracranial hypertension, this condition can cause pulsatile tinnitus, among other symptoms like headache and vision changes, due to increased intracranial pressure.
Do Not Miss Diagnoses
- Glomus Jugulare Tumor: A rare, benign tumor located in the jugular foramen that can cause pulsatile tinnitus due to its proximity to the auditory nerve and middle ear structures. Early diagnosis is crucial for effective treatment.
- Carotid Artery Stenosis or Aneurysm: Although less common, significant carotid artery disease can cause pulsatile tinnitus. Missing this diagnosis could lead to severe consequences, including stroke.
- Dural Arteriovenous Fistula (DAVF): An abnormal connection between arteries and veins in the dura mater, which can cause pulsatile tinnitus. DAVFs can lead to serious complications if not treated promptly.
Rare Diagnoses
- Superior Semicircular Canal Dehiscence: A rare condition where there is an abnormal opening in the bone overlying the superior semicircular canal of the inner ear, leading to hearing internal sounds, including pulsatile tinnitus and hyperacusis.
- Vascular Malformations of the Middle Ear: Rare abnormalities in the blood vessels of the middle ear, which can cause pulsatile tinnitus.
- Otosclerosis with a Patulous Cochlear Aqueduct: A rare condition where there is an abnormal connection between the cochlea and the cerebrospinal fluid space, potentially causing pulsatile tinnitus and other auditory symptoms.