Multiple Venous Malformations as a Cause of Pulsatile Tinnitus

Ayham Al Afif,Uthman Alamoudi,Ahmed A Al-Sayed,Manohar Bance

doi:10.1155/2020/8867963

Abstract

Introduction Pulsatile tinnitus is a relatively common presentation in otolaryngology clinics, most cases of which have a treatable cause. This presentation warrants a thorough workup to identify treatable, and rule out life-threatening, etiologies. We present a case of a patient with pulsatile tinnitus arising from multiple dilated venous channels in the head and neck. Case Presentation. We present the case of a 65-year-old Caucasian female with a two-year history of progressive, bilateral pulsatile tinnitus, which had become debilitating. Computed-tomographic angiography (CTA) studies ruled out an intracranial vascular cause for her symptoms. However, computed tomography (CT) scanning and magnetic resonance imaging (MRI) revealed multiple dilated bilateral, low-flow, venous channels throughout the head and neck. The proximity of such dilated venous channels to the temporal bone provides a route for sound to be transmitted to the inner ear. Conclusion Arterial, venous, and systemic etiologies can cause pulsatile tinnitus. Arteriovenous malformations (AVMs) of the head and neck represent less than 1% of cases. In our patient, dilated low-flow venous malformations are the likely source of her symptoms, which is the first reported case in the literature.

Highlights

Pulsatile tinnitus is a relatively common presentation in otolaryngology clinics, most cases of which have a treatable cause. is presentation warrants a thorough workup to identify treatable, and rule out life-threatening, etiologies
Sismanis et al have highlighted that computed tomography (CT) and CT-angiography (CTA) studies are most helpful in identifying arterial, and retrotympanic, causes of pulsatile tinnitus such as glomus tumors and Arteriovenous malformations (AVMs) or AVFs
magnetic resonance imaging (MRI) and MR angiography (MRA) studies are preferred in patients with a potential venous etiology [8,9,10]

Summary

Introduction

Tinnitus is defined as the perception of sound without external stimulus. It is divided broadly into 2 categories: nonpulsatile and pulsatile tinnitus. Pulsatile tinnitus can arise from abnormal blood flow through dilated or stenotic vessel lumens within the head and neck, resulting in turbulent and audible blood flow. It can stem from amplified bone conduction of normal physiological sounds within the inner ear, as seen in superior semicircular canal dehiscence (SSCD) syndrome. Sismanis et al have highlighted that CT and CT-angiography (CTA) studies are most helpful in identifying arterial, and retrotympanic, causes of pulsatile tinnitus such as glomus tumors and AVMs or AVFs. Alternatively, MRI and MR angiography (MRA) studies are preferred in patients with a potential venous etiology [8,9,10]

Case Report

Findings

Discussion