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Clinical Challenge
July 15, 2021

Pulsatile Tinnitus in a Patient With a Skull Base Lesion

Author Affiliations
  • 1Otolaryngology–Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, Michigan
  • 2Department of Neurotology, Michigan Ear Institute, Farmington Hills
JAMA Otolaryngol Head Neck Surg. 2021;147(9):822-823. doi:10.1001/jamaoto.2021.1510

An 80-year-old woman presented with a 1-year history of right pulsatile tinnitus and aural fullness. Her symptoms were more prominent at night and in the quiet and improved when upright. Physical examination demonstrated an intact tympanic membrane with no middle ear mass; there was no neck mass palpated or bruit auscultated. The patient had further workup with magnetic resonance imaging (MRI) and a computed tomographic scan (Figure 1). The patient was taken to the operating room for a right transtemporal biopsy. Operative findings demonstrated extensive tumor extending along the posterior fossa dura and deep to the jugular foramen that filled the area of the skull base. The tumor was debulked and sent for pathologic evaluation.

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