When alarm bells ring: emergency tinnitus

OBJECTIVE: The aim of this study is to develop a diagnostic-therapeutic algorithm for those suffering from tinnitus who seek emergency aid. MATERIALS AND METHODS: A literature review has been performed on articles from the last 30 years. RESULTS: It is important to activate medical or surgical diagnostic and therapeutic strategies, in order to safeguard and rehabilitate the various functions affected. Psychiatric comorbidity is the most frequent pathological condition of those with serious or catastrophic tinnitus. In these cases, mortality risk is linked to suicide, morbidity to tinnitus-correlated distress. CONCLUSIONS: Tinnitus, mainly linked to loss of hearing, is a frequent symptom among the population at large. About 7% of those affected by tinnitus turn to their doctor to solve their problem, while between 0.5 and 2% request urgent medical assistance. Their cry for help may be the result of an acute onset of tinnitus or the rapid impairment of an already chronic condition. Tinnitus is not considered an urgent ear, nose and throat (ENT) condition by the Associazione Otorinolaringologi Ospedalieri Italiani (AOOI) [Italian Association of Hospital ENT], even though there are many pathological conditions, sometimes serious, associated with tinnitus and emergency action is necessary to reduce the risk of morbidity and mortality

Vascular loop in the cerebellopontine angle causing pulsatile tinnitus and headache

Tinnitus is a common disorder, it can be classified as pulsatile and non-pulsatile or objective and subjective. Pulsatile tinnitus is less common than non-pulsatile and can be due to vascular tumour such as glomus or vascular abnormality. We presented an interesting case of a 30 year-old Malay lady with a two-year history of pulsatile tinnitus which was worsening in three months duration. It was associated with intermittent headache. Clinical examination and tuning fork test were unremarkable. Apart from mild hearing loss at high frequency on the left ear, the pure tone audiogram (PTA) was otherwise normal. In view of the patient’s young age with no risk factor for high frequency loss, a magnetic resonance imaging (MRI) was performed to look for any abnormality in the cerebellopontine angle. It revealed a single vessel looping around the left vestibulocochlear and facial nerves at the cisternal portion, likely a branch of the anteroinferior cerebellar artery (AICA). Literature review on the pathophysiology and treatment option in this condition is discussed

NdYAG laser treatment of a glomus tympanicum tumour

Glomus tympanicum tumours are highly vascular tumours of the middle ear. Their removal by conventional surgical methods requires an extensive procedure in many cases, often with ossicular disarticulation to allow adequate exposure prior to the 'chaotic' and haemorrhagic event of tumour removal. This paper reports on the use of an NdYAG laser in a case of a large glomus tympanicum tumour. The laser facilitated a transcanal approach, avoided ossicular disarticulation and allowed accurate and almost bloodless ablation of the entire tumour.The NdYAG laser appears to be a very useful treatment modality in the management of these highly vascular tumours. Care should be taken to avoid accidental energy transmission to the cochlea

Pulsatile tinnitus —a review of 84 patients

Pulsatile tinnitus can be annoying for a patient and can also be the only clue to a potentially devastating and life-threatening disease. In order to understand its clinical spectrum and management better we analysed the files of 84 patients seen at our institution over a 10-year period. Noninvasive techniques (ultrasound, computed tomography, magnetic resonance imaging) and angiography were employed as investigations tailored to the individual patient. A vascular disorder [i.e. arteriovenous fistula, dissection of the internal carotid artery (ICA), fibromuscular dysplasia, aneurysm of the ICA and sinus thrombosis] was found in 36 patients (42%), most commonly a durai arteriovenous fistula or a carotid-cavernous sinus fistula. In 26 patients with a vascular abnormality, pulsatile tinnitus was the presenting symptom. In 12 patients (14%), nonvascular disorders such as glomus tumour or intracranial hypertension with a variety of causes explained the tinnitus. We conclude that patients with pulsatile tinnitus should be investigated with noninvasive techniques. If these are negative or to clarify abnormal findings of noninvasive techniques selective angiography is needed for diagnosis and to guide treatmen

Therapeutic embolization of the dural arteriovenous malformation involving the jugular bulb.

Pulsatile tinnitus is a rarely occurring symptom of vascular origin. Most frequently, the symptoms are due to an arteriovenous malformation, to a tumor of the jugular glomus or to a local arterial stenosis. A 39-yr-old Korean male suffering from pulsatile tinnitus of the left ear was diagnosed to have dural arteriovenous malformation of the jugular bulb. Magnetic resonance imaging and angiography revealed a high-velocity vascular lesion encroaching the internal jugular vein and sigmoid sinuses. Digital subtraction angiography demonstrated a dural arteriovenous malformation involving the jugular bulb. The arterial supply was from the neuromeningeal branch of the left ascending pharyngeal artery and inferior tympanic artery. Stenosis of the left jugular vein caused retrograde venous drainage through the contralateral transverse sinus. Superselective embolization of these feeding arteries was successfully performed using 25% mixture of N-butylcyanoacrylate and lipiodol. In postembolization period, his complaints of pulsatile tinnitus and buzzing noise behind his left ear disappeared

Diagnosis dan Tata Laksana Tinitus Pulsatil

Tinitus pulsatil merupakan kasus yang jarang dijumpai, terjadi akibat adanya gangguan vaskular atau malformasi pembuluh darah. Tinitus pulsatil umumnya terjadi unilateral, terdengar seirama dengan jantung, berdenyut dan mengganggu aktivitas. Tata laksana yang dilakukan adalah mengatasi penyebab tinitus dan manajemen diri untuk mengurangi gejala tinitus. Tujuan laporan kasus ini memaparkan kasus tinitus pulsatil. Kasus pertama, perempuan 51 tahun keluhan utama telinga kanan berdengung disertai nyeri kepala dan hiperlipidemia. Otoskopi dan hasil pemeriksaan audiologi telinga kanan normal. Hasil Transcranial Color-Coded Duplex (TCCD)  didapatkan stenosis arteri cerebri. Hasil Digital Substraction Angiography (DSA) didapatkan stenosis di sinus transversosigmoid junction kanan. Hasil MRI tak tampak neurovascular compression. Kasus kedua, perempuan 57 tahun telinga kanan berdengung, bila leher ditekan suara dengung berkurang, otoskopi dan hasil pemeriksaan audiologi dalam batas normal.  Hasil TCCD & DSA didapatkan stenosis arteri cerebri. Hasil MRI terdapat singgungan antara anterior inferior cerebellar artery dengan proksimal nervus vestibulocochlearis kanan.  Kedua kasus dilakukan konseling, habituasi dengan hasil tinitus menetap, pasien teradaptasi dengan tinitusnya. Telah dilaporkan 2 kasus tinitus pulsatil yang diakibatkan oleh stenosis arteri carotis. Kedua kasus ini dilakukan tata laksana habituasi, konseling.  Hasil dari evaluasi adalah tinitus menetap dan teradaptasi.

Multiple Venous Malformations as a Cause of Pulsatile Tinnitus.

INTRODUCTION: Pulsatile tinnitus is a relatively common presentation in otolaryngology clinics, most cases of which have a treatable cause. This presentation warrants a thorough workup to identify treatable, and rule out life-threatening, etiologies. We present a case of a patient with pulsatile tinnitus arising from multiple dilated venous channels in the head and neck. Case Presentation. We present the case of a 65-year-old Caucasian female with a two-year history of progressive, bilateral pulsatile tinnitus, which had become debilitating. Computed-tomographic angiography (CTA) studies ruled out an intracranial vascular cause for her symptoms. However, computed tomography (CT) scanning and magnetic resonance imaging (MRI) revealed multiple dilated bilateral, low-flow, venous channels throughout the head and neck. The proximity of such dilated venous channels to the temporal bone provides a route for sound to be transmitted to the inner ear. CONCLUSION: Arterial, venous, and systemic etiologies can cause pulsatile tinnitus. Arteriovenous malformations (AVMs) of the head and neck represent less than 1% of cases. In our patient, dilated low-flow venous malformations are the likely source of her symptoms, which is the first reported case in the literature.Peer Reviewe

Vertebro-vertebral fistula presenting as a pulsatile tinnitus

Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus, resulting in an estimated prevalence of 10% to 15% in adults. Tinnitus may be classified as pulsatile (PT) or continuous (non-PT), and may be subjective (heard only by the patient) or objective (also audible to the examiner). PT is usually related to vascular causes and is pulse synchronous (coinciding with the patient's heartbeat). PT is much less common affecting approximately 4% of patients with tinnitus, but unlike non-PT, usually has a specific identifiable cause. We present a case of a man without previous otological disease or head trauma, with a left-ear subjective PT. MR angiography detected a left vertebro-vertebral arteriovenous fistula, which was treated by endovascular embolisation with important symptomatic relief.info:eu-repo/semantics/publishedVersio

Subtyping somatic tinnitus: a cross-sectional UK cohort study of demographic, clinical and audiological characteristics

Somatic tinnitus is the ability to modulate the psychoacoustic features of tinnitus by somatic manoeuvres. The condition is still not fully understood and further identification of this subtype is essential, particularly for the purpose of establishing protocols for both its diagnosis and treatment. This study aimed to investigate the characteristics of somatic tinnitus within a large UK cohort using a largely unselected sample. We believe this to be relatively unique in comparison to current literature on the topic. This was investigated by using a total of 608 participant assessments from a set of recognised tinnitus and audiology measures. Results from a set of chi-square tests of association found that amongst the individuals with somatic tinnitus, a higher proportion had pulsatile tinnitus (different from heartbeat), were under the age of 40, reported variation in the loudness of their tinnitus and reported temporomandibular joint (TMJ) disorder. The same pattern of results was confirmed using a multivariate analysis of the data based on logistic regression. These findings have strong implications towards the profiling of somatic tinnitus as a distinct subtype of general tinnitus