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Pulsatile tinnitus may present a diagnostic problem, because it does not always have an easily detectable cause. It is frequently associated with a vascular condition, which can be of congenital or acquired origin. Pulsatile tinnitus that has an arterial pathogenesis is often associated with atherosclerotic carotid artery disease, especially in elderly patients, as well as with tortuous intracranial arteries and hypertension; less frequently, vascular abnormalities are characterized by arteriovenous fistulae and aneurysms. The venous form is usually associated with congenital venous abnormalities and/or intracranial hypertension of various origins.1 The nonvascular causes of pulsatile tinnitus include palatal, stapedial, and tensor tympani muscle myoclonus,1 as well as vascular neoplasms of the temporal bone.2 When neoplasms involving the temporal bone or the skull base have been excluded, the diagnostic process involved in the onset of pulsatile tinnitus that is presumably caused by noncongenital phenomena requires an accurate imaging study, and it is possible that the exact pathogenesis will remain unknown.
Pirodda A, Modugno GC, Brandolini C, Savastio G. How Computed Tomography May Be Useful in Pulsatile Tinnitus With Normal Otoscopic Findings. Arch Otolaryngol Head Neck Surg. 2005;131(8):728–729. doi:10.1001/archotol.131.8.728
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