Endovascular surgical neuroradiology specialist, Sky Ridge Medical Center
What is pulsatile tinnitus and is it something to be concerned about?
Pulsatile tinnitus is a rhythmic “whooshing’ or “roaring” noise perceived in the ear. The disturbance is related to blood flow so it is synchronous with the heartbeat. Pulsatile tinnitus is not the continuous ringing or buzzing noises experienced with sensorineural hearing loss or after being subjected to loud noises — this is termed subjective tinnitus.
Besides just the rhythmic sound, pulsatile tinnitus can be associated with headache, vision changes, numbness, tingling, weakness, dizziness, problems with balance, insomnia or depression. In most patients, pulsatile tinnitus is continuous. In some cases, the noise improves or worsens with head turning, lying down or pressing on the soft tissues behind or below the ear.
Pulsatile tinnitus can indicate a potentially serious underlying disorder such as atherosclerosis (plaque build up in the arteries), high blood pressure, narrowed or torn blood vessels, increased pressure inside the head, vascular tumors, blood clots, aneurysms or an arteriovenous fistula (AVF), which is an abnormal, pressureized connection between an artery and vein. Some causes result from normal anatomical variances and are not dangerous — these are only treated when they lead to a serious sleep, memory or psychological disorder. Some causes are dangerous and carry a high risk of stroke or brain bleeding (i.e. AVF or aneurysms). Blood clots are 30 times more common at altitude than at sea-level.
Imaging is always indicated for pulsatile tinnitus. A special type of MRI or CT scan that focuses on blood vessels of the head and neck is usually performed first. Unfortunately, these exams can still miss dangerous causes of pulsatile tinnitus. In some cases, a minimally invasive procedure called a cerebral angiogram may be necessary. This procedure is performed by a physician specializing in interventional neuroradiology, also known as neurointerventional surgery. A small tube is placed in the femoral artery overlying the hip and guided into the vessels of the neck where robotic x-ray sources are used to study the vessels of the head and neck. If a serious cause is discovered, an endovascular surgery called embolization may be indicated to repair or block a vascular malformation. In some cases, open surgery may be performed by an Ear, Nose and Throat (ENT) specialist or ear surgeon to remove a vascular tumor.
If you have an abnormal sound in one or both of your ears, see a doctor, preferably an ENT or audiology specialist. If the abnormal sound is pulsatile and in sync with your heartbeat, make sure that you see a neuro-interventional specialist. Your condition could be serious.
Sky Ridge Medical Center has launched a pulsatile tinnitus clinic to address this serious medical issue.
If you have any of the “whooshing” symptoms Dr. Loy discussed, please call 720-225-4327 to speak to a Sky Ridge navigator who can guide you through the process.
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