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Clinical Challenge
Radiology
May 2018

Pulsatile Tinnitus With Imaging

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor
  • 2Division of Otology–Neurotology, Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2018;144(5):451-452. doi:10.1001/jamaoto.2018.0014

A woman in her 40s presented with right pulsatile tinnitus. She reported constant pulsatile tinnitus with a whooshing quality for 4 years. Factors exacerbating her symptoms included holding her breath and turning her head to the left. She reported that compression of her right neck and turning her head to the right decreased the loudness of the tinnitus. She had not experienced hypertension, vertigo, sleep apnea, hyperthyroidism, hearing loss, head trauma, history of ear infections, otorrhea, rhinorrhea, ear surgery, or family history of ear problems. The external auditory canals were clear bilaterally. Tympanic membranes were intact and mobile bilaterally. There was no evidence of any vascular masses in the middle ear space. Results from testing with tuning forks were normal. Toynbee stethoscope revealed a bruit in the right ear that could be stopped with gentle compression of the right side of the neck. An audiogram showed hearing within normal limits with slight air-bone gaps present at 250, 1000, and 3000 Hz on the right and within normal limits on the left. Speech reception threshold on the right was 10 dB with a word recognition score of 100% bilaterally. The tympanogram result revealed type A bilaterally, and acoustic reflexes were all present. A computed tomographic (CT) temporal bone scan was completed (Figure 1).

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