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Suggest Treatment For Vascular Tinnitus
Question: 5-6 month duration of a pulsating sound/bruit right ear/head/or even behind ear(not sure exactly where I hear it. No other clinical findings: (-) headaches, (-)sinus problems or infections, some slight hearing loss in the right ear over many years though. Test Ultrasound, MRI Brain w/o contrast and another MRI (Multiplanar Time-of-flight MR angiography and MR venography of the head was obtained w/o contrast) basically the results between the two MR are: no evidence of aneurysm, no evidence of hemodynamics lily significant stenosis, occlusion or dissection. No evidence of venous sinus thrombosis. No evidence of intracranial or skull base mass. Mild signal abnormality in the Right Mastoid. Nasal septum deviated to left. I saw a neuro interventional radiologist today and he referred me to a ENT. Talked about the signal abnormality of the Right mastoid. I feel fine no sinus or ear problems just the whooshing that is positional. Tilt my head to the left and it stops. Also if I palpate behind my ear (occipital artery?) it stops. Radiologist said I was not in danger of stroke aneurysm bleed etc but to see the ENT. I'm worried. Please help
Brief Answer:
Pulsatile or Vascular Tinnitus.
Detailed Answer:
Hi,
Thank you for your query.
1. This seems to be Pulsatile or Vascular Tinnitus and is due to increased or turbulent blood flow in the vicinity of the inner ear. Confirm if this is synchronous with the heartbeat.
2. Rule out the the following conditions:
a. A hearing loss detected by a Pure Tone Audiogram (PTA).
b. Routine ear examination to rule out earwax or fluid build up behind the ear drum detected by a Tympanogram (Impedance Audiogram).
c. Aanemia (Low hemoglobin).
d. Color doppler study of Neck vessels including the occipital area and vertebro-basilar arteries).
e. Cervical spine X-rays to rule out cervical spondylosis.
( *d & e: since the tinnitus stops when you tilt the head to the left).
f. Blood tests for thyroid hormones, cholesterol (Lipid Profile - triglycerides are raised).
g. Temporal bone scans may pick up an aberrant blood vessel (rare). Upload any images that you have.
h. Patulous Eustachian tube.
i. Benign Intracranial Hypertension (get an eye examination done).
j. Myoclonus of the ear muscles.
k. A dental reference for ruling out TMJD (Temporo-Mandibular Joint Disorders). Check if the tinnitus changes when you clench your teeth.
3. If the above investigations are normal, the cause may not be found (idiopathic). Kindly let me know the results of your tests. This will help in suggesting further treatment. Most medications for tinnitus are given to improve blood flow to the inner ear. This may worsen your pulsatile tinnitus. Tinnitus cannot be cured, though it may disappear on its's own or be controlled by treatment.
4. Tinnitus matching may be tried. The blood supply of the cochlea is from various arterial branches and within the cochlea, there is a difference between the basal turn (high frequency) and the mid/apical segment (low frequency).
5. I would agree that from your MRI findings and general health that you are not at risk for any cerebro-vascular accident.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Pulsatile or Vascular Tinnitus.
Detailed Answer:
Hi,
Thank you for your query.
1. This seems to be Pulsatile or Vascular Tinnitus and is due to increased or turbulent blood flow in the vicinity of the inner ear. Confirm if this is synchronous with the heartbeat.
2. Rule out the the following conditions:
a. A hearing loss detected by a Pure Tone Audiogram (PTA).
b. Routine ear examination to rule out earwax or fluid build up behind the ear drum detected by a Tympanogram (Impedance Audiogram).
c. Aanemia (Low hemoglobin).
d. Color doppler study of Neck vessels including the occipital area and vertebro-basilar arteries).
e. Cervical spine X-rays to rule out cervical spondylosis.
( *d & e: since the tinnitus stops when you tilt the head to the left).
f. Blood tests for thyroid hormones, cholesterol (Lipid Profile - triglycerides are raised).
g. Temporal bone scans may pick up an aberrant blood vessel (rare). Upload any images that you have.
h. Patulous Eustachian tube.
i. Benign Intracranial Hypertension (get an eye examination done).
j. Myoclonus of the ear muscles.
k. A dental reference for ruling out TMJD (Temporo-Mandibular Joint Disorders). Check if the tinnitus changes when you clench your teeth.
3. If the above investigations are normal, the cause may not be found (idiopathic). Kindly let me know the results of your tests. This will help in suggesting further treatment. Most medications for tinnitus are given to improve blood flow to the inner ear. This may worsen your pulsatile tinnitus. Tinnitus cannot be cured, though it may disappear on its's own or be controlled by treatment.
4. Tinnitus matching may be tried. The blood supply of the cochlea is from various arterial branches and within the cochlea, there is a difference between the basal turn (high frequency) and the mid/apical segment (low frequency).
5. I would agree that from your MRI findings and general health that you are not at risk for any cerebro-vascular accident.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had a hearing test and ear exam. ( Very old equipment) Normal and no wax. Hemoglobin 13.5 taken in (November) I also had an Ultrasound Carotid Duplex Dop Bilateral. Are you requesting to see the actual Ultrasound and my MRI disc? Not sure I know how to send them to you ( I have to ask my kids) hahahah! For the triglycerides: diet, excercise and fish oil. And lastly I'm due for an eye exam. When I saw the ENT this was prior to my MRI's where they noted the mild signal abnormality in the right mastoid. I have not been back to the ENT. I then saw a Neurologist and then a Neurointerventional Radiologist who reviewed the MRI's but not the Ultrasound. He showed me the mastoid area on MRI and then wants me to see a different ENT specialists whom he recommends
Brief Answer:
Need to see the images to evaluate the mastoid changes.
Detailed Answer:
Hi,
Thank you for writing back.
1. Yes, I need to see the actual images to evaluate the mastoid.
2. Mastoiditis may be one of the causes of an inflammation in the area. But this does not explain why the tinnitus stops when you tilt the head or put pressure in the occipital area.
3. Did you check for changes in the tinnitus when you clench your jaw tightly?
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Need to see the images to evaluate the mastoid changes.
Detailed Answer:
Hi,
Thank you for writing back.
1. Yes, I need to see the actual images to evaluate the mastoid.
2. Mastoiditis may be one of the causes of an inflammation in the area. But this does not explain why the tinnitus stops when you tilt the head or put pressure in the occipital area.
3. Did you check for changes in the tinnitus when you clench your jaw tightly?
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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