In outpatient clinics, it is common to hear patients talk about “the constant ‘thump-thump’ sound in the ear like the beating of the heart”, which may indicate that you have “vascular pulsatile tinnitus”.
What is vascular pulsatile tinnitus?
Vascular pulsatile tinnitus is abnormal changes in blood vessels or turbulent flow in the blood vessels, resulting in abnormal noises that travel into the cochlea so that the patient can hear a murmur consistent with their pulse. Its main feature is that the sound has a pulsating rhythm, which is consistent with the patient’s pulse and heartbeat. The effects of pulsatile tinnitus on patients vary, ranging from mild tinnitus in a quiet environment to severe tinnitus affecting the patient’s work and life.
Vascular pulsatile tinnitus can be roughly divided into two categories, one is arterial tinnitus and the other is venous tinnitus. In addition, pulsatile tinnitus can also occur in some vascular-rich tumors in the temporal bone, such as jugular globe tumor and tympanic globe tumor.
The pathogenic factors of arterial tinnitus include intracranial and intracranial arteriovenous malformations, vascular stenosis and aneurysm caused by atherosclerosis, arteriovenous fistula, etc.; the pathogenesis of venous tinnitus Factors are sigmoid sinus diverticulum or bone defect, transverse or sigmoid sinus stenosis, or benign intracranial hypertension syndrome.
What tests are needed for vascular pulsatile tinnitus?
First of all, conduct some routine physical examination, look around the ear, external auditory canal, tympanic membrane, auscultation in front of the ear, behind the ear, mastoid or neck and scalp, in order to understand Whether there are vascular murmurs at these sites.
Secondly, an audiology examination is required. The sensitivity of the patient to sound is tested by pure tone audiometry to determine the degree of hearing loss; the middle ear is examined with the help of tympanogram; conventional high-resolution CT of the temporal bone And CT arteriovenous imaging and other specific observations are which part of the blood vessels have problems, in addition to exclude tumor lesions.
Cranial MRI arteriovenous imaging + 4D flow and other new imaging technologies can collect blood flow imaging of patients in multiple directions, and determine the cause of tinnitus according to the blood flow velocity and whether there is turbulence or eddy current formation. The specific location is convenient for more accurate and comprehensive treatment of the lesions. Most of the arteriovenous fistulas or vascular malformations require vascular intervention. Sigmoid sinus diverticulum can be treated surgically to correct abnormal vascular structure in time, so as to achieve the purpose of controlling tinnitus.
Vascular pulsatile tinnitus is more common in women, which is related to the secretion of hormones in women, emotional fluctuations, and daily stress. There are many causes of vascular pulsatile tinnitus, and the diagnosis is complicated. However, through detailed medical history, detailed physical examination and targeted imaging examinations, most of the causes can be identified, and corresponding treatment measures can be taken according to the causes, so as to improve the symptoms to the greatest extent or even cure.
