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Pulsatile Tinnitus

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Textbook of Tinnitus

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Abstract

Pulsatile tinnitus (PT) is characterized by an auditory perception of pulse-synchronous sound. An alteration in the vascular hemodynamics causing turbulent flow, a vibration of a dehiscent vascular wall, or third window lesions are potential mechanisms of PT. Vascular PT can be subdivided into arterial, arteriovenous, and venous lesions. When the patient complains of psychoacoustic characteristics of PT, detailed physical examination and audiological evaluation complemented by etiology-targeted laboratory tests can provide diagnostic clues. Moreover, radiological evaluations such as brain magnetic resonance imaging (MRI) with angiography, temporal bone high-resolution computed tomography (CT), Doppler ultrasonography, and classical transfemoral cerebral angiography are recommended. Of various pathologies causing PT, dehiscence or diverticulum of the sigmoid sinus or jugular bulb is the most common cause that can be cured by surgical or interventional treatments. In addition, benign intracranial hypertension (BIH) is a common cause of PT. Although 15–50% of patients present with no definite diagnosis even after a meticulous diagnostic workup, the identification of the causal vascular pathology is vital for the optimal treatment of PT because successful surgical or interventional management is available in many cases.

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Abbreviations

AV:

Arteriovenous

AVF:

Arteriovenous fistula

AVM:

Arteriovenous malformation

BIH:

Benign intracranial hypertension

CSF:

Cerebrospinal fluid

CT:

Computed tomography

dAVF:

Dural Arteriovenous fistula

DSA:

Digital subtraction angiography

DSSD:

Dominant sigmoid sinus with/without dehiscence

ICA:

Internal carotid artery

LFHL:

Low-frequency hearing loss

MRI:

Magnetic resonance imaging

PT:

Pulsatile tinnitus

SCDS:

Semicircular canal dehiscence syndrome

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Jae-Jin Song

  2. Section of Neurosurgery, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand

    Dirk De Ridder

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  1. Jae-Jin Song
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  2. Dirk De Ridder
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Correspondence to Jae-Jin Song .

Editor information

Editors and Affiliations

  1. Institute for Information and Process Management, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland

    Winfried Schlee

  2. Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg, Bezirksklinikum,, Regensburg, Germany

    Berthold Langguth

  3. Department of Surgical Sciences, University of Otago, Dunedin, New Zealand

    Dirk De Ridder

  4. School of Psychology, Global Brain Health Institute & Trinity College of Dublin Institute for Neuroscience, Dublin, Dublin, Ireland

    Sven Vanneste

  5. Department of Otorhinolaryngology – Head and Neck Surgery, University Hospital of Zurich, University of Zurich, Switzerland, Switzerland

    Tobias Kleinjung

  6. Neuroscience Program, University of Texas, Dallas School of Brain & Behavioral Sciences, Richardson, TX, USA

    Aage R. Møller

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Song, JJ., De Ridder, D. (2024). Pulsatile Tinnitus. In: Schlee, W., Langguth, B., De Ridder, D., Vanneste, S., Kleinjung, T., Møller, A.R. (eds) Textbook of Tinnitus. Springer, Cham. https://doi.org/10.1007/978-3-031-35647-6_40

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