Imaging findings in Pulsatile Tinnitus
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- čas přidán 6. 06. 2024
- In this video, Dr. Katie Bailey talks about the imaging findings of pulsatile tinnitus. Pulsatile tinnitus is a ringing or abnormal sound sensation in the ear, but unlike the most common high frequency tinnitus, it has a pulsatile or wavelike quality that can often oscillate with arterial or venous flow. Causes of pulsatile tinnitus are unique and a different approach is warranted.
0:00 General approach and common causes. Some findings are best seen on CT and others are best seen on MRI. For this reason, you can often perform either a CT or MRI when you begin. There are a wide range of possible causes that can be categorized into neoplasm, arterial, and venous.
0:49 Paragangliomas. Glomus tympanicum, or tympanicum paraganglioma, is the most common middle ear tumor. These are more common in women than men. The most common location is along the floor of the middle ear adjacent to the cochlea. A glomus tympanicojugulare has features of both a jugular paraganglioma and tympanic paraganglioma, often connecting them. On MRI, these appear as permeative masses with bone destruction and enhancement.
2:31 Vestibular schwannoma is the most common tumor of the internal auditory canal and usually arise from the inferior vestibular nerve. These are solidly enhancing masses that extend from the IAC into the cerebellopontine angle.
3:20 Other tumors that can occur in or around the region include meningiomas and chondrosarcomas. Meningiomas are usually homogeneously enhancing and may have dural tails. Chondrosarcomas are often centered around the petroclival junction.
4:06 Arterial anomalies can also cause pulsatile tinnitus. If the internal carotid artery extends into the middle ear with no bony covering, this is an aberrant ICA. A persistent stapedial artery can also cause pulsatile tinnitus. The absence of foramen spinosum suggests a variant with no middle meningeal artery and a persistent stapedial artery.
5:30 Other vascular causes include vascular loops and microvascular compression of the nerves in the IAC. These can also cause pulsatile tinnitus, although the role of an AICA loop has been controversial. Other carotid abnormalities such as carotid stenosis, dissection, or fibromuscular dysplasia are also associated with tinnitus.Hemangiomas, or encapsulated venous vascular malformations, are benign vascular malformations which have high flow
7:22 Venous abnormalities can also cause tinnitus. These may be a more constant tinnitus or hum with less arterial type pulsation. Absence of the bony wall around the jugular bulb is known as a dehiscent jugular bulb. Venous diverticula from the sigmoid sinus or jugular vein are small outpouchings of the vein, almost like aneurysms. Other vascular malformations such as dural AV fistulas and arteriovenous malformations can cause tinnitus, and can be confirmed on vascular imaging studies. Idiopathic intracranial hypertension causes stenosis of the lateral transverse sinuses which can also cause tinnitus.
10:07 A few other things can cause pulsatile tinnitus, such as cotospongiosis/otosclerosis and Paget disease.
Overall, a number of things can cause pulsatile tinnitus, but a few of these things are more common so you should keep your eye out for them.
Check out this video and additional content on www.learnneuroradiology.com
Great lectures, great teacher. Thank for kind teachers like you to share excellent lectures, learners all over world can benefit.
So nice of you
Very Informative Video.
Thanks for tuning in!
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Thank you! 😃
Really informative video for something that can sometimes have a difficult cause to pinpoint. Mine was caused by a mass that originally seemed to be a glomus tympanicum that pathology found to be a hemangioma that happened to form at the cochlear promontory. I've heard this location isn't very common for hemangiomas.
Wow, that truly is unique. Hemangiomas or vascular tumors can occur all over the body but that is a pretty unusual location!
great
Great Video, Now what can be done? What's the treatment??..
Well, depends on the cause. A tumor would be removed. A vascular anomaly would have to be treated, either with endovascular treatment or surgery. Vascular variants are tricky because they can be present but not be the cause of the tinnitus, so usually further evaluation is needed. There are probably other videos out there on this topic, but it's beyond my expertise because it's really surgery/interventional neuroradiology.
It is amazing presentation
Glad you think so!
Mine has gotten so bad recently that I can feel the heartbeat in my left ear at all times and can hear it always when quiet. It’s not loud but very bothersome not knowing why. I plan on going to my doctor soon. Freaks me out
It's tough because it's actually normal to hear your own heartbeat sometimes. This can be concerning but many times isn't anything to worry about.
If it gets severe or is bothering you too much, it can be a sign of something else. Good idea to ask a doctor about it in that case.
Good luck
What about a cyst on the pituitary gland leaning on optic nerve
This exists. Sometimes Rathke cleft cysts or cystic adenomas can deflect the optic nerve or optic chiasm
AVMs and AVFs are not venous anomalies. Although technically they are arteriovenous lesions, they are usually classified as arterial causes of PT; because for purely venous causes the whoosh is obliterated by compressing the ipsilateral jugular vein. That's not true for arteriovenous lesions. PT arising from a DAVF can be obliterated by compressing the occipital artery though. It's the first I'm seeing this kind of classification.
This video is not intended to be a classification of arteriovenous abnormalities, which people have been arguing about for 50 years. It is an introductory level video describing the scope of abnormalities that may be seen on cross sectional imaging. For the level of detail you are describing you probably need more specialized references.
Thanks for tuning in though and happy Thanksgiving to all in the US.
If you stick your finger in your ear and pulsatile tinnitus stops, can it still be these issues above? Or the pulsatile tinnitus in those cases still goes on no matter what you do
You know, I don't know the answer to this question. Most pulsatile tinnitus gets louder when you plug the external canal because your silencing external sounds which can cover it up.
It's possible that plugging the ear is compressing a vessel which is causing the tinnitus though. Just a thought?
These cases are complex and it can be very hard to get the answer!
What investigation should be done if there is unilateral pulsatile tinnitus and on same side of IJV is pulasting on Doppler
I would probably start with an MR angiogram. If you have arterialized flow in the vein, then there could be an abnormal connection or fistula between them. That said, it's common for the internal jugular to have some pulsatility.
I live near St. Louis and I have been suffering from Pulsatile Tinnitus for a little over a month now. I have discovered a doctor named Athos Patsalides who specializes in this problem, but he is based out of New York. Does anyone know a doctor closer to the St. Louis area who is knowledgeable in diagnosing and/or treating Pulsatile Tinnitus? I am having a difficult time finding someone who might be able to help me. My symptoms are getting worse. Something weird is going on inside my head. Any contact information someone might be willing to provide would be greatly appreciated.
I think you probably need to see an otolaryngologist (ENT surgeon) who specializes in tinnitus. They can hep you figure out what imaging studies might be helpful and make sure it isn't caused by infection or fluid in your middle ear. Good luck.
@@LearnNeuroradiology Thank you!
@@LearnNeuroradiology wrong!! They don’t know 💩 either!!