title: Pulsatile tinnitus: imaging and differential diagnosis.
abstract: BACKGROUND
  Pulsatile tinnitus, unlike idiopathic tinnitus, usually has a specific, identifiable cause. Nonetheless, uncertainty often arises in clinical practice about the findings to be sought and the strategy for work-up.
  
  
  METHODS
  Selective literature review and evaluation of our own series of patients.
  
  
  RESULTS
  Pulsatile tinnitus can have many causes. No prospective studies on this subject are available to date. Pulsatile tinnitus requires both a functional organ of hearing and a genuine, physical source of sound, which can, under certain conditions, even be objectified by an examiner. Pulsatile tinnitus can be classified by its site of generation as arterial, arteriovenous, or venous. Typical arterial causes are arteriosclerosis, dissection, and fibromuscular dysplasia. Common causes at the arteriovenous junction include arteriovenous fistulae and highly vascularized skull base tumors. Common venous causes are intracranial hypertension and, as predisposing factors, anomalies and normal variants of the basal veins and sinuses. In our own series of patients, pulsatile tinnitus was most often due to highly vascularized tumors of the temporal bone (16%), followed by venous normal variants and anomalies (14%) and vascular stenoses (9%). Dural arteriovenous fistulae, inflammatory hyperemia, and intracranial hypertension were tied for fourth place (8% each).
  
  
  CONCLUSIONS
  The clinical findings and imaging studies must always be evaluated together. Thorough history-taking and clinical examination are the basis for the efficient use of imaging studies to reveal the cause of pulsatile tinnitus.
authors.affiliation: Klinikum Fulda gAG, Department of Neuroradiology, Germany. ehofmann.raz@klinikum-fulda.de
authors.forename: Erich
authors.initials: E
authors.lastname: Hofmann
authors.forename: Robert
authors.initials: R
authors.lastname: Behr
authors.forename: Tobias
authors.initials: T
authors.lastname: Neumann-Haefelin
authors.forename: Konrad
authors.initials: K
authors.lastname: Schwager
mesh_terms: D002561:Cerebrovascular Disorders / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis; D014012:Tinnitus / Q000175:diagnosis* / Q000209:etiology