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Cerebrovascular pulsatile tinnitus: causes, treatments, and outcomes in 164 patients with neuroangiographic correlation
  1. Daniel D Cummins1,
  2. M Travis Caton2,
  3. Kafi Hemphill3,
  4. Allison Lamboy2,
  5. Adelyn Tu-Chan3,
  6. Karl Meisel3,
  7. Kazim H Narsinh2,
  8. Matthew R Amans2
  1. 1School of Medicine, University of California San Francisco, San Francisco, California, USA
  2. 2Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
  3. 3Neurology, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Matthew R Amans, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA; matthew.amans{at}ucsf.edu

Abstract

Background Pulsatile tinnitus (PT) can cause significant detriment to quality of life and may herald a life-threatening condition. Endovascular evaluation is the gold standard for the definitive diagnosis of PT and facilitates treatment. However, no large study has determined the distribution of causes and treatment outcomes of PT evaluated endovascularly.

Methods Consecutive patients evaluated at a multidisciplinary PT clinic from a single academic center were retrospectively reviewed. Patients with a suspected cerebrovascular etiology of PT based on clinical and/or non-invasive imaging, who were evaluated by endovascular techniques (arteriography, venography, manometry, and/or balloon test occlusion), were included in analysis. Baseline clinical features and treatment results by final etiology of PT were compared.

Results Of 552 patients referred for PT evaluation, 164 patients (29.7%) who underwent endovascular evaluation of PT were included. Mean (±SD) age at first clinical evaluation was 54.3±14.1 years (range 25–89 years); 111 patients (67.7%) were female. PT causes were 75.6% vascular and 24.4% non-vascular. Arteriovenous shunting lesions caused 20.7% of cases, venous etiologies 48.2%, and arterial etiologies 6.7%. Of patients with a shunting lesion treated with endovascular embolization, 96.9% had lasting significant improvement or resolution in PT. Endovascular stenting for venous sinus stenosis gave 84.6% of patients lasting improvement or resolution in PT. Arterial and non-vascular PT had fewer patients treated endovascularly and less improvement in PT symptoms.

Conclusion PT with a suspected vascular cause is most often attributable to venous etiologies. PT caused by arteriovenous shunting or venous sinus stenosis may be effectively treated endovascularly.

  • Balloon
  • Angiography
  • Embolic
  • Fistula
  • Stent

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

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Footnotes

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  • DDC and MTC contributed equally.

  • Contributors Contributions: DDC: conceptualization, data collection, analysis, drafting original manuscript. MTC: conceptualization, data collection, analysis, drafting original manuscript. KH: data collection, revising original manuscript. AL: data collection, revising original manuscript. AT-C: conceptualization, oversight, revising original manuscript. KM: conceptualization, oversight, revising original manuscript. KHN: conceptualization, oversight, revising original manuscript. MRA: conceptualization, oversight, revising original manuscript. MRA is the guarantor for this work and accepts responsibility for the data presented and controlled the decision to publish.

  • Funding This work was funded in part by the National Institute of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) of the NIH under the award number R56HL149124-01 and by the Office of the Assistant Secretary of Defense for Health Affairs through the Peer Reviewed Research Program under award number PR201091.

  • Competing interests MRA: Board member: Mind Rhythm; Consultancy: Stryker, Neurovascular, Covidien, MicroVention, Comments: Pipeline proctor for Covidien and PHIL DSMB for MicroVention; Patents (planned, pending or issued): Cerebral venous sinus stent, Comments: provisional patent serial number 62/984,549. KHN: Consultancy: Stryker Neurovascular, Imperative Care. All other authors: No relevant competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.