From the Guidelines
Pulsatile tinnitus in a patient with normal cardiac evaluations and no symptoms likely indicates a vascular cause that requires further investigation. This condition, characterized by hearing a rhythmic sound synchronized with the heartbeat, can stem from various non-cardiac vascular abnormalities. The patient should undergo additional imaging studies such as CT angiography, MRI/MRA, or Doppler ultrasound of the head and neck to identify potential causes like arteriovenous malformations, venous anomalies, vascular tumors, or carotid artery stenosis 1.
Key Considerations
- The normal cardiac findings are reassuring but don't exclude vascular causes outside the heart.
- Consultation with an otolaryngologist and possibly a neurovascular specialist is recommended for comprehensive evaluation.
- While pulsatile tinnitus itself isn't typically dangerous, it can occasionally signal underlying conditions that require treatment.
- Patients should monitor for any new symptoms like dizziness, hearing loss, or neurological changes while awaiting specialist evaluation, as these could indicate progression of the underlying condition.
Imaging Recommendations
- Temporal bone CT and CTA are appropriate to evaluate for a middle ear mass or vascular etiology in patients with pulsatile tinnitus 1.
- MRI may be considered as a noninvasive alternative to screen for a suspected intracranial vascular malformation.
- Dedicated temporal bone CT reconstructions can be created from the high-resolution source CTA images without additional radiation exposure to the patient 1.
Clinical Approach
- A thorough history, physical examination, and audiometry are helpful for elucidating a cause of tinnitus 1.
- Imaging should be guided by the presence of other symptoms such as hearing loss, vertigo, previous head trauma, and neurological deficits.
- Patients with unilateral or asymmetrical tinnitus with additional neurological, otological, and head and neck symptoms are more likely to have an underlying causative pathology than patients with no additional symptoms or patients with bilateral tinnitus 1.
From the Research
Pulsatile Tinnitus Inference
Given a patient with a normal EKG and echocardiogram, as well as no symptoms, pulsatile tinnitus can be a complex condition to infer from.
- The provided studies do not directly address the relationship between a normal EKG, echocardiogram, and pulsatile tinnitus.
- Studies 2, 3, 4, and 5 focus on antiplatelet therapy in the context of carotid stenting and thrombectomy, which may not be directly relevant to pulsatile tinnitus.
- Study 6 discusses the effect of pre-incident antiplatelet therapy on sudden sensorineural hearing loss, but its findings may not be applicable to pulsatile tinnitus.
- There is no clear evidence to support a specific inference about pulsatile tinnitus in this scenario.
Limitations of Current Evidence
- The available studies do not provide a clear connection between pulsatile tinnitus and the patient's normal EKG and echocardiogram results.
- More research is needed to understand the relationship between these factors and pulsatile tinnitus.
- The current evidence does not allow for a definitive inference about the patient's condition.