Pulsatile Tinnitus and Coronary Artery Stenting: No Established Relationship
There is no established relationship between coronary artery disease (CAD) stent placement and improvement in pulsatile tinnitus symptoms. The improvement you observed is likely coincidental rather than causally related.
Why This Connection Is Not Supported
Anatomic and Pathophysiologic Considerations
Pulsatile tinnitus results from turbulent blood flow in vessels near the auditory apparatus, specifically the carotid arteries, vertebral arteries, jugular veins, or intracranial vessels—not coronary arteries 1, 2, 3.
Coronary artery stenting addresses myocardial perfusion and has documented benefits for angina relief and quality of life in patients with chronic coronary disease, but these effects are mediated through improved cardiac blood flow, not cerebrovascular or otologic circulation 4.
The coronary circulation is anatomically and hemodynamically isolated from the carotid-vertebrobasilar system that supplies the structures responsible for pulsatile tinnitus 1, 5.
Evidence for Vascular Causes of Pulsatile Tinnitus
Atherosclerotic carotid artery disease (ACAD) is a recognized cause of pulsatile tinnitus, with ipsilateral carotid endarterectomy achieving 92% (12 of 13) cure rates when the stenosis is proximal 1.
Carotid artery stenosis causing pulsatile tinnitus typically involves the extracranial, petrous, or supraclinoid segments of the internal carotid artery—locations where turbulent flow can be transmitted to the middle and inner ear 2, 3.
Stenting of carotid stenoses has documented immediate relief of pulsatile tinnitus in 89% (17 of 19) of cases, with resolution occurring within minutes to hours of the procedure 1, 2, 3.
The mean age of patients with pulsatile tinnitus from ACAD is 59 years, and these patients typically have cardiovascular risk factors including hypertension, diabetes, and hyperlipidemia 5.
Alternative Explanations for Your Observation
Temporal Coincidence
- Spontaneous resolution of pulsatile tinnitus can occur through collateral vessel development, changes in blood pressure, or alterations in cardiac output that may coincidentally align with the timing of coronary intervention 5, 6.
Hemodynamic Changes
- Improved cardiac function after coronary revascularization may alter systemic hemodynamics, potentially affecting blood pressure or cardiac output in ways that could theoretically modify flow patterns in carotid vessels, though this mechanism is not documented in the literature 4.
Medication Effects
Antiplatelet therapy (aspirin plus P2Y12 inhibitor) initiated after coronary stenting could theoretically affect platelet-mediated vascular reactivity, though no evidence supports this improving pulsatile tinnitus 7.
Beta-blockers, calcium channel blockers, or other cardiovascular medications adjusted around the time of stenting might alter heart rate or vascular tone in ways that could affect pulsatile tinnitus perception 7.
Recommended Evaluation
If Pulsatile Tinnitus Recurs or Persists
Obtain color Doppler ultrasonography of the carotid arteries to evaluate for ipsilateral carotid stenosis, which is found in 11.76% of patients with pulsatile tinnitus and cardiovascular risk factors 5.
Auscultate for ipsilateral carotid bruit, which is present in 100% of patients with pulsatile tinnitus from ACAD and is typically louder than the subjective tinnitus 6.
Consider CT angiography or MR angiography of the head and neck if Doppler ultrasonography is negative, to evaluate for petrous or intracranial carotid stenosis, vertebral artery stenosis, or vascular malformations 2, 3.
Critical Pitfall to Avoid
Do not attribute pulsatile tinnitus improvement to coronary stenting without excluding carotid or vertebrobasilar pathology, as this could delay diagnosis of a treatable and potentially stroke-producing lesion 5, 6.
Pulsatile tinnitus may be the first manifestation of severe (>70%) carotid stenosis in patients with cardiovascular risk factors, making prompt vascular evaluation essential 5.