Symptoms: Pulsatile Tinnitus and Hearing Loss

We report the unique finding of a petrous apex cholesterol granuloma associated with a paraganglioma, also known as a glomus jugulare tumor, in a 52-year-old woman who presented to our department with pulsatile tinnitus, hearing loss, aural fullness, and disequilibrium. She had been treated for a petrous apex cholesterol granuloma 20 years earlier, at which time she had undergone drainage of the granuloma via subtotal petrous apicectomy. When she came to our facility approximately 20 years later, she had signs and symptoms consistent with a jugular paraganglioma, which was likely to have been present at the time of her initial presentation for the cholesterol granuloma. In fact, microscopic bleeding from the paraganglioma might have led to the formation of the cholesterol granuloma. The metachronous presentation of these two entities, which to our knowledge has not been reported previously in the literature, indicates the potential association of paragangliomas with the formation of cholesterol granulomas of the petrous apex.

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Inner Ear Conductive Hearing Loss and Unilateral Pulsatile Tinnitus Associated with a Dural Arteriovenous Fistula: Case Based Review and Analysis of Relationship between Intracranial Vascular Abnormalities and Inner Ear Fluids

Case Reports in Otolaryngology ◽

10.1155/2015/817313 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6

Author(s):

Ettore Cassandro ◽

Claudia Cassandro ◽

Giuliano Sequino ◽

Alfonso Scarpa ◽

Claudio Petrolo ◽

...

Keyword(s):

Hearing Loss ◽

Arteriovenous Fistula ◽

Inner Ear ◽

Dural Arteriovenous Fistula ◽

Conductive Hearing Loss ◽

Pulsatile Tinnitus ◽

Vascular Abnormalities ◽

First Case ◽

Conductive Hearing ◽

Inner Ear Fluids

While pulsatile tinnitus (PT) and dural arteriovenous fistula (DAVF) are not rarely associated, the finding of a conductive hearing loss (CHL) in this clinical picture is unusual. Starting from a case of CHL and PT, diagnosed to be due to a DAVF, we analyzed relationship between intracranial vascular abnormalities and inner ear fluids. DAVF was treated with endovascular embolization. Following this, there was a dramatic recovery of PT and of CHL, confirming their cause-effect link with DAVF. We critically evaluated the papers reporting this association. This is the first case of CHL associated with PT and DAVF. We describe the most significant experiences and theories reported in literature, with a personal analysis about the possible relationship between vascular intracranial system and labyrinthine fluids. In conclusion, we believe that this association may be a challenge for otolaryngologists. So we suggest to consider the possibility of a DAVF or other AVMs when PT is associated with CHL, without alterations of tympanic membrane and middle ear tests.

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Dilated petrosquamosal sinus, mastoid emissary vein, and external jugular vein: A rare cause of pulsatile tinnitus, vertigo, and sensorineural hearing loss

Indian Journal of Otology ◽

10.4103/0971-7749.91196 ◽

2011 ◽

Vol 17 (3) ◽

pp. 123 ◽

Cited By ~ 2

Author(s):

B Alqahtani ◽

H Alsherhri ◽

M Alqahtani

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Jugular Vein ◽

External Jugular Vein ◽

Sensorineural Hearing ◽

Pulsatile Tinnitus ◽

Emissary Vein ◽

Mastoid Emissary Vein

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Aberrant internal carotid artery causing objective pulsatile tinnitus and conductive hearing loss

Acta Oto-Laryngologica ◽

10.3109/00016489.2012.684400 ◽

2012 ◽

Vol 132 (10) ◽

pp. 1126-1130 ◽

Cited By ~ 11

Author(s):

Yue-Shuai Song ◽

Yong-Yi Yuan ◽

Guo-Jian Wang ◽

Pu Dai ◽

Dong-Yi Han

Keyword(s):

Hearing Loss ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Conductive Hearing Loss ◽

Pulsatile Tinnitus ◽

Aberrant Internal Carotid Artery ◽

Conductive Hearing

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Arterial anomalies of the middle ear associated with stapes ankylosis

The Journal of Laryngology & Otology ◽

10.1017/s0022215100126398 ◽

1994 ◽

Vol 108 (3) ◽

pp. 237-239 ◽

Cited By ~ 18

Author(s):

A. Pirodda ◽

G. Sorrenti ◽

A. F. Marliani ◽

I. Cappello

Keyword(s):

Hearing Loss ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Conductive Hearing Loss ◽

Pulsatile Tinnitus ◽

Aberrant Internal Carotid Artery ◽

Conductive Hearing ◽

Angiographic Findings ◽

Arterial Anomalies

AbstractAn aberrant internal carotid artery in a young woman complaining of pulsatile tinnitus and conductive hearing loss was diagnosed pre-operatively by CT scan and angiographic findings. An exploratory tympanotomy was performed in order to evaluate the cause of the severe conductive hearing loss. It was possible to detect a large persistent stapedial artery associated with a stapedial fixation of unknown cause. Despite these vascular anomalies a stapedotomy was performed successfully.

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Case Report: 56-year-old Woman Presenting with Progressive Hearing Loss, Chronic Otitis Media and Pulsatile Tinnitus

International Journal of Medical Students ◽

10.5195/ijms.2019.341 ◽

2019 ◽

Vol 7 (1) ◽

pp. 11-14

Author(s):

Luis Morejon-Troya ◽

Joyce Jimenez-Zambrano

Keyword(s):

Hearing Loss ◽

Radiation Therapy ◽

Latin American ◽

Chronic Otitis Media ◽

Massive Bleeding ◽

Pulsatile Tinnitus ◽

Management Options ◽

Progressive Hearing Loss ◽

Glomus Tumors ◽

Tumor Management

Introduction: Glomus tumors are rare benign lesions of the middle ear that are often associated with symptoms of progressive hearing loss and pulsatile tinnitus. Diagnosis is often delayed due to the slow growth of the tumor, and surgical resections of the mass are the mainstay treatment. Case Presentation: A 56-year-old Latin American female was admitted to the hospital with a year-long history of intermittent pulsatile buzzing noise, progressive hearing loss, pain and discharge of the left ear. High-resolution Computerized Tomography and Magnetic Resonance Imaging revealed evidence of an enhancing mass lesion, which extended into the external auditory canal. A tympanomastoidectomy was performed. Most of the mass was removed, but some remained because of massive bleeding. The patient received 3 months of radiation therapy after the tympanic paraganglioma was surgically removed. Conclusion: This case exposed the audiological findings, the location, and the extent of the tumor. Management options consist of radiation therapy and surgical management, depending on the size of the tumor. Early detection of glomus tumors is essential to prevent non-reversible complications.

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The use of magnetic resonance imaging in the investigation of patients with unilateral non-pulsatile tinnitus without asymmetrical hearing loss

The Journal of Laryngology & Otology ◽

10.1017/s002221512100150x ◽

2021 ◽

pp. 1-4

Author(s):

C Saxby ◽

F Koumpa ◽

S Mohamed ◽

A Singh

Keyword(s):

Magnetic Resonance Imaging ◽

Hearing Loss ◽

Magnetic Resonance ◽

Vestibular Schwannoma ◽

Case Series ◽

Vestibular Schwannomas ◽

Pulsatile Tinnitus ◽

Internal Auditory Meatus ◽

Resonance Imaging ◽

Imaging Evaluation

Abstract Background Tinnitus is a common condition presenting to the ENT out-patient clinic. Vestibular schwannomas are benign cerebellopontine angle tumours that usually present with unilateral sensorineural hearing loss. Magnetic resonance imaging of the internal auditory meatus is the definitive investigation in their detection. The current recommendation is for unilateral tinnitus patients to undergo magnetic resonance imaging of the internal auditory meatus to exclude vestibular schwannoma. Objective To evaluate magnetic resonance imaging in the investigation of patients with unilateral non-pulsatile tinnitus without asymmetrical hearing loss. Method A retrospective case series was conducted of all patients who underwent magnetic resonance imaging of the internal auditory meatus to investigate unilateral non-pulsatile tinnitus without asymmetrical hearing loss, from 1 January 2014 to 1 January 2019. Results Of 2066 scans, 566 (27 per cent) were performed to investigate patients (335 female, 231 male) with unilateral non-pulsatile tinnitus without asymmetrical hearing loss. Three vestibular schwannomas were detected on imaging, and 134 incidental findings were discovered. Conclusion The detection rate of vestibular schwannoma in this group was just 0.3 per cent. This paper questions the utility of magnetic resonance imaging evaluation in these patients.

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Superior petrosal sinus causing superior canal dehiscence syndrome

The Journal of Laryngology & Otology ◽

10.1017/s0022215117001013 ◽

2017 ◽

Vol 131 (7) ◽

pp. 593-597 ◽

Cited By ~ 3

Author(s):

S M D Schneiders ◽

J W Rainsbury ◽

E F Hensen ◽

R M Irving

Keyword(s):

Computed Tomography ◽

Hearing Loss ◽

Clinical Signs ◽

Signs And Symptoms ◽

Pulsatile Tinnitus ◽

Computed Tomography Imaging ◽

Tomography Imaging ◽

Superior Canal Dehiscence ◽

Superior Petrosal Sinus ◽

Canal Dehiscence

AbstractObjective:To determine signs and symptoms for superior canal dehiscence syndrome caused by the superior petrosal sinus.Methods:A review of the English-language literature on PubMed and Embase databases was conducted, in addition to a multi-centre case series report.Results:The most common symptoms of 17 patients with superior petrosal sinus related superior canal dehiscence syndrome were: hearing loss (53 per cent), aural fullness (47 per cent), pulsatile tinnitus (41 per cent) and pressure-induced vertigo (41 per cent). The diagnosis was made by demonstration of the characteristic bony groove of the superior petrosal sinus and the ‘cookie bite’ out of the superior semicircular canal on computed tomography imaging.Conclusion:Pulsatile tinnitus, hearing loss, aural fullness and pressure-induced vertigo are the most common symptoms in superior petrosal sinus related superior canal dehiscence syndrome. Compared to superior canal dehiscence syndrome caused by the more common apical location of the dehiscence, pulsatile tinnitus and exercise-induced vertigo are more frequent, while sound-induced vertigo and autophony are less frequent. There is, however, considerable overlap between the two subtypes. The distinction cannot as yet be made on clinical signs and symptoms alone, and requires careful analysis of computed tomography imaging.

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Assessment of Objective Pulsatile Tinnitus in a Patient with Syringohydromyelia

Journal of the American Academy of Audiology ◽

10.3766/jaaa.18.3.2 ◽

2007 ◽

Vol 18 (03) ◽

pp. 197-205

Author(s):

James R. Steiger ◽

Patricia A. Saccone ◽

Karen N. Watson

Keyword(s):

Hearing Loss ◽

Fluid Pressure ◽

Low Frequency ◽

Pulsatile Tinnitus ◽

Cochlear Aqueduct ◽

Endolymphatic Duct ◽

Stapes Footplate ◽

Vascular Structures ◽

Cochlear Partition ◽

Tinnitus Masking

We examined a 38-year-old male with syringohydromyelia and concomitant symptoms suggestive of intracranial hypertension including unilateral low-frequency sensorineural hearing loss and objective pulsatile tinnitus. The tinnitus was heard by the authors (through a hearing aid stethoscope tube), measured objectively (with a probe microphone), measured subjectively (as minimum masking levels and with fixed frequency Bekesy), and altered by changes in ear canal pressure (subjectively reported and measured objectively with a probe microphone). The audiologic symptoms were likely associated with elevated cerebrospinal fluid pressure that traveled to the cochlea through the cochlear aqueduct. The tinnitus may have originated from pulsations of central vascular structures that traveled through the cochlear aqueduct or the endolymphatic duct. Hearing loss likely resulted from tinnitus masking or a stiffening of the cochlear partition or stapes footplate. Examinamos un hombre de 38 años con siringohidromielia y con síntomas concomitantes sugestivos de hipertensión intracraneana, que incluían una hipoacusia sensorineural unilateral de bajas frecuencia y un acúfeno pulsátil. El acúfeno fue escuchado por los autores (por medio de un estetoscopio para auxiliares auditivos), medido objetivamente (con una sonda micrófono), medido subjetivamente (como niveles mínimos de enmascaramiento y con un Bekesy de frecuencia fija), y alterado por cambios en la presión del canal auditivo (reportados subjetivamente y medidos objetivamente por una sonda micrófono). Los síntomas audiológicos estuvieron asociados con elevaciones en la presión del líquido cefalorraquídeo que viaja a la cóclea a través del acueducto coclear. El acúfeno debe haberse originado a partir de pulsaciones en las estructuras vasculares centrales, que viajaban por el acueducto coclear o el ducto endolinfático. La hipoacusia debe haber resultado del enmascaramiento del acúfeno o de un aumento en la rigidez en la partición coclear o en la platina del estribo.

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