EC: Pulsatile Tinnitus

The following information was taken from Syed F. Ahsan, MD, Michael Seidman, MD, and Kathleen Yaremchuk, MD., published in ENTtoday, a publication of The Triologic Society, April 2016, p. 4. Their epublication may be found in Laryngoscope. 2015;125:284-285.

Pulsatile tinnitus (PT) is a relatively rare cause of tinnitus. It makes up about 4% of patients with tinnitus which, in turn, affects up to 10% of the U.S. population. PT can be described as objective or subjective, as well as venous, arterial, or nonvascular. About 20% of PT patients will have objective tinnitus. Incidence of abnormal, often treatable, structural findings in patients with PT has been noted to be high, ranging from 44% to 91%.

PT can be a result of vascular as well as neoplastic causes. If left undiagnosed, PT can lead to significant morbidity and mortality. Overlooking an aneurysm or tumor may be catastrophic for the patient. Therefore, further investigation is highly recommended.

Deciding on the initial radiographic evaluation in patients with unilateral PT can be challenging due to the many causes as well as the questionable results of some of the imaging findings. Sensitivity and specificity analyses have shown that computerized tomographic angiography (CTA) may be the best initial imaging modality in patients with unilateral subjective PT.

For patients with objective PT with no middle ear mass, a CTA is the best initial examination. For those patients with subjective unilateral PT, it is important to distinguish between venous and arterial PT. For patients with signs and symptoms of idiopathic intracranial hypertension (IIH or BIH), magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) are the appropriate initial studies.

For the remaining cases of venous and arterial PT, a CTA should be considered as the best initial study due to safety and broad effectiveness.


1. Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, severity, exposures, and treatment pattterns of tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. 2016;142(10):959-965.

Last revised January 3, 2017