title: Metastatic breast carcinoma presenting as unilateral pulsatile tinnitus: a case report.
abstract: Pulsatile tinnitus is a rare symptom, yet it may herald life-threatening pathology in the absence of other symptoms or signs. Pulsatile tinnitus tends to imply a vascular cause, but metastatic disease also can present in this way. Clinicians should therefore adopt a specific diagnostic algorithm for pulsatile tinnitus and always consider the possibility of metastatic disease. A history of malignant disease and new cranial nerve palsies should raise clinical suspicion for skull base metastases. We describe the case of a 63-year-old woman presenting with unilateral subjective pulsatile tinnitus and a middle ear mass visible on otoscopy. Her background included the diagnosis of idiopathic unilateral vagal and hypoglossal nerve palsies 4 years previously, with normal magnetic resonance imaging (MRI). Repeat MRI and computed tomography imaging were consistent with metastatic breast carcinoma. This case raises important questions about imaging protocols and the role of serial scanning in patients at high risk of metastatic disease.
authors: Department of ENT, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, Hampshire, U.K.
authors: Andrew
authors: A
authors: Moore
authors: Max
authors: M
authors: Cunnane
authors: Jason C
authors: JC
authors: Fleming
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000150:complications* / Q000556:secondary; D002528:Cerebellar Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000556:secondary; D002530:Cerebellopontine Angle; D005260:Female; D006801:Humans; D008875:Middle Aged; D014012:Tinnitus / Q000209:etiology*