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Pulsatile Tinnitus: Differential Diagnosis and Approach to Management

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Abstract

Purpose of Review

The purpose of this review is to provide an updated approach to the evaluation and management of pulsatile tinnitus (PT), an uncommon but often treatable subtype of tinnitus.

Recent Findings

Secondary PT can be due to either vascular or non-vascular etiologies, including, but not limited to: neoplasm, arteriovenous malformation or fistula, idiopathic intracranial hypertension, dural venous sinus stenosis, otoacoustic etiologies (e.g., otosclerosis, patulous eustachian tube) and bony defects (e.g., superior semicircular canal dehiscence). Computed tomography (CT) and magnetic resonance imaging (MRI) imaging have comparable diagnostic yield, though each may be more sensitive to specific etiologies. If initial vascular imaging is negative and a vascular etiology is strongly suspected, digital subtraction angiography (DSA) may further aid in the diagnosis. Many vascular etiologies of PT can be managed endovascularly, often leading to PT improvement or resolution. Notably, venous sinus stenting is an emerging therapy for PT secondary to idiopathic intracranial hypertension with venous sinus stenosis.

Summary

Careful history and physical exam can help establish the differential diagnosis for PT and guide subsequent evaluation and management. Additional studies on the efficacy and long-term outcome of venous sinus stenting for venous stenosis are warranted.

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Data Availability

No datasets were generated or analysed during the current study.

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Acknowledgements

We sincerely appreciate the medical illustration team of Mayo Clinic, specifically Mr. Jim Postier, for the assistance in the illustration used in this article.

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  1. Department of Neurology, Mayo Clinic Health System, Mankato, MN, USA

    Han Wang

  2. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Jennifer I. Stern, Carrie E. Robertson & Chia-Chun Chiang

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H.W. and J.S. wrote the main manuscript. H.W. prepared Table 1. C.R. revised the manuscript critically. All authors reviewed the manuscript.

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Correspondence to Han Wang.

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Wang, H., Stern, J.I., Robertson, C.E. et al. Pulsatile Tinnitus: Differential Diagnosis and Approach to Management. Curr Pain Headache Rep (2024). https://doi.org/10.1007/s11916-024-01263-1

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