Unusual Causes of Pulsatile Tinnitus: Case-Based Review

• Main Authors: Thaj, Jabin, Owa, Anthony, Kumar, Gaurav
• Format: Conference Proceeding
• Language: English
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0036-1592499

Objective: Vascular abnormalities are the most common radiological findings in the patients with pulsatile tinnitus. It is a well-established fact that most common differential diagnosis of pulsatile tinnitus is glomus tumor. We present three unusual cases of pulsatile tinnitus which were managed in our skull base unit. Method: Retrospective case note analysis of involved patients from January 1, 2013, till December 31, 2015. The first patient who presented with pulsatile tinnitus was subsequently diagnosed to have Wegener granulomatosis. This experienced later helped us to expedite the diagnosis in our second patient who again presented with pulsatile tinnitus. The subsequent investigations revealed she had an adenocarcinoma of the mastoid and middle ear. She underwent a subtotal petrosectomy. Our third patient with pulsatile tinnitus was found out to have a basal cell carcinoma and also underwent a subtotal petrosectomy. Conclusion: Our initial diagnosis of Wegener raised our index of suspicion for possible unusual pathology that could be associated with this presentations. Therefore the second and third cases were rapidly and thoroughly worked up which helped us to arrive at the diagnosis of cancer. Apart from the well-known differential diagnosis discussed above we propose diagnostic pathway for pulsatile tinnitus which can be secondary to rapidly proliferating tissue under tension thereby leading to the pulsation. If the MRI is negative for glomus, the patient has to be thoroughly evaluated for unusual but potentially serious etiologies.