박동성 이명의 진단과 치료의 최신 지견

Abstract

Pulsatile tinnitus (PT), in general, is not related to pathology of the auditory system. Although PT is not as common as non-pulsatile tinnitus, the diagnosis and treatment of PT is important as it is reported to be found in as much as 4% of general population and treatable vascular causes are found in 44~91% of subjects with PT. Three types of vascular origins (arterial, arteriovenous, and venous) of pulsatile tinnitus exist and the main causes of pulsatile tinnitus are related to aberrant/ectopic, stenosis, diverticulum, bony wall dehiscence, or other pathologies of blood vessels, either arterial or venous. Brain MRI with angiography, temporal bone high-resolution CT, Doppler ultrasonography, and classical transfemoral cerebral angiography are radiological diagnostic tools for pulsatile tinnitus, but basic findings at the outpatients’ clinic such as subjective psychoacoustic nature of the PT, otoendoscopic findings, and audiologic features are also very important as these can be of great help for the physicians to obtain presumptive diagnostic impression for each subject with PT. Dehiscence/diverticulum of the sigmoid sinus one of the most common surgically correctable venous cause of PT. Additionally, benign intracranial hypertension is also a very common cause of PT that should not be forgotten in obese PT subjects with normal radiologic findings. In this review, diagnostic steps and appropriate surgical- or interventional management options for each cause of PT will be discussed in detail. (J Clinical Otolaryngol 2021;32:26-39)