Differential Diagnosis for Pulsatile Tinnitus
Single Most Likely Diagnosis
- Benign Intracranial Hypertension (BIH): This condition, also known as idiopathic intracranial hypertension, is characterized by increased pressure within the skull without any evidence of a tumor or other intracranial pathology. It often presents with pulsatile tinnitus, headache, and visual disturbances, particularly in young, obese women.
Other Likely Diagnoses
- Middle Ear Problems: Conditions such as a middle ear infection, otosclerosis, or a perforated eardrum can cause pulsatile tinnitus due to the abnormal transmission of sound.
- Vascular Tumors or Malformations: Abnormalities like glomus tumors or arteriovenous malformations (AVMs) in the head or neck can lead to pulsatile tinnitus due to the turbulent blood flow.
- Atherosclerotic Carotid Artery Disease: Narrowing or blockage of the carotid arteries can cause pulsatile tinnitus, especially if the stenosis is significant and leads to abnormal blood flow.
- Anemia or Thyrotoxicosis: Both conditions can lead to an increase in blood flow, which may be perceived as pulsatile tinnitus.
Do Not Miss Diagnoses
- Giant Cell Arteritis: Although less common, this condition can lead to pulsatile tinnitus and is a medical emergency due to the risk of vision loss if not promptly treated.
- Dural Arteriovenous Fistula (DAVF): A rare condition where there is an abnormal connection between arteries and veins in the covering of the brain, which can cause pulsatile tinnitus and has the potential for serious complications if left untreated.
- Carotid Artery Dissection: A tear in the wall of the carotid artery can lead to pulsatile tinnitus and is a risk factor for stroke.
Rare Diagnoses
- Paget's Disease of the Bone: A chronic condition that can affect the bones of the skull, leading to abnormal bone growth and potentially causing pulsatile tinnitus.
- Ototoxicity from Certain Medications: Some medications, such as certain antibiotics or chemotherapy agents, can cause damage to the ear and lead to pulsatile tinnitus as a rare side effect.
- 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, which can cause a variety of auditory symptoms, including pulsatile tinnitus.