PULSATILE TINNITUS IN ENT AND HEAD NECK SURGERY

1. Tinnitus

2. Pulsatile tinnitus
• Perception of sound is not that of a continuous form
• The perceived sound  form of a pulsation, clicking or fluttering
• Specific subtype of tinnitus management different
• Classified
↓
synchronous
 non-synchronous

3. Pathological causes of pulsatile tinnitus

4. Synchronous pulsatile tinnitus
• Synchronous pulsatile tinnitus may result of abnormal
vascular anatomy in the vicinity of the peripheral auditory
system.
• Systemic aberrations ofthe circulation hyperdynamic
circulation role in development
• Idiopathic intracranial hypertension or pseudotumor cerebri
gaining attention as the cause of synchronous pulsatile
tinnitus
• Superior semicircular canal dehiscence syndrome beginning
to gain attention as the cause

5. Investigation
• Simple bood test  to exclude anaemia and thyrotoxicosis.
• Contrast-enhanced computed tomography of temporal bone,
scalp, brain If otoscopy reveals a retrotympanic mass
• duplex carotid ultrasonography atherosclerotic carotid artery
disease
• Angiographic imaging often reserved for severe recalcitrant
cases
• Ophthalmological assessment,lumbar puncture If idiopathic
intracranial hypertension is suspected

6. Treatment
Supportive
• When no obvious cause is identified, providing reassurance
These patients  CBT or TRT
• Sound therapies subjective idiopathic tinnitus

7. Surgerical management of pulsatile tinnitus
• Depending on the causative pathology treatments may
include decompressive and destructive procedures
• Microvascular decompression of vascular loops vascular
loops -close proximity to the cochlear nerves of patients with
tinnitus

8. Non-synchronous pulsatile tinnitus
• Tinnitus may manifest itself as a train of rhythmical clicks or a
buzzing or fluttering noise or sensation that is not synchronous
with the pulse.
• Sounds often related to myoclonic activity middle ear muscle
• Other muscles within the head and neck region like palatal
muscle
• Contraction tensor tympani and/or stapedius muscle -
>clicking or buzzing noise
• Tinnitus muscle contraction noise,vibration of the tympanic
membrane or movement of the ossicular chain

9. INVESTIGATION
• Tympanometry middle ear myoclonus
• MRI recommended to exclude a pathology with the triangle of
Guillain–Mollaret palatal myoclonus
↓
palatal myoclonus

10. TREATMENT
Pharmological
• use of benzodiazepines,orphenadrine,
carbamazepine,piracetamand botulinum toxin
Supportive treatment
• Relaxation therapy,psychotherapy,tinnitus maskingand
biofeedback
Surgical
• surgical division of the middle ear tendons(both tensor tympani
and stapedius)