Pulsatile Tinnitus: A Review of the Literature and an Unusual Case of Iatrogenic Pneumocephalus Causing Pulsatile Tinnitus

Pulsatile tinnitus caused by pneumocephalus after Janneta surgery

Pulsatile tinnitus of nonvascular origin is rare. We herein present a case of pulsatile tinnitus complicated with Jannetta surgery due to a communication created between the drilled mastoid cells and epidural space. She was successfully cured by otological surgery where the mastoid tip was packed with bone cement. A 68-year-old woman was referred to the previous hospital with complaints of right autophony, aural fullness, hyperacusis to her footsteps, and pulsatile tinnitus for the past three years. She had received Jannetta surgery for right hemifacial spasm seven years before. The computed tomography (CT) of the right temporal bone showed bony dehiscence between the mastoid cells and posterior cranial fossa. She underwent otological surgery to obliterate the tip of the mastoid cavity with artificial bone cement (BIOPEX^Ⓡ) under general anesthesia. Her annoying aural symptoms were immediately abolished and she has been free from symptoms at ten months after surgery. It is critical to ensure the closure of any communication created between the middle ear and epidural space during surgeries in order to prevent the occurrence of pulsatile tinnitus.

Aberrant sylvian vein: A newly described cause of pulsatile tinnitus

We herein report a newly described cause of venous pulsatile tinnitus: protrusion of an aberrant sylvian vein into the tympanum. A 60-year-old woman presented with a 4-month history of objective persistent pulsatile tinnitus in the right ear with no other complaints. The pulsatile tinnitus diminished with rotation of the head to the right side or by compression of the right cervical vascular structures. The frequency and intensity of the tinnitus were 125 Hz and 20 dB HL, respectively. Audiometry and otoscopic examination findings were normal. Radiologic examination showed that the right sylvian vein protruded into the tympanum through the dehiscent anterior cortical plate of the tympanum.

Movement of the tympanic membrane causing pulsatile tinnitus

Background: Movement of the tympanic membrane can be a cause of pulsatile tinnitus. There are many etiologies that cause movement of the tympanic membrane, including otogenic pneumocephalus. This is an uncommon presentation after head injury that may be missed as the diagnosis of the primary cause of the symptoms.

Objective: To report a rare case of pulsatile tinnitus because of otogenic pneumocephalus.

Methods: Case report from chart review with relevant investigations and treatment.

Results: We describe the very interesting case of a patient who presented with pulsatile tinnitus because of otogenic pneumocephalus. On examination, we found a moving tympanic membrane. A CT scan revealed pneumocephalus in the right temporoparietal region that was continuous with the adjacent mastoid air cells. There was a transverse fracture through the mastoid process. A meticulous mastoidectomy with unroofing of the epitympanum was performed with widening of the aditus ad antrum. The mastoid cavity was closed without fat obliteration. After the operation, the pulsatile tinnitus ceased completely.

Conclusion: Mastoidectomy and unroofing the epitympanum without fat obliteration is a very simple and effective option for the treatment of pulsatile tinnitus because of pneumocephalus.

Focal defect of mastoid bone shell in the region of the transverse-sigmoid junction: a new cause of pulsatile tinnitus

Objective:

Pulsatile tinnitus usually originates from vascular structures, causing an arterial or venous bruit. We report a new cause of pulsatile tinnitus: a focal defect of the mastoid bone shell in the region of the transverse-sigmoid junction, with a normal transverse-sigmoid sinus.

Participants and intervention:

Three patients complained of unilateral, pulsatile tinnitus present for many years. They were identified as having a focal defect of the mastoid bone shell in the region of the transverse-sigmoid junction. The patients underwent transmastoid reconstruction of the mastoid bone shell overlying the transverse-sigmoid sinus.

Results:

All three patients reported immediate resolution of their symptoms, and were asymptomatic at final follow up.

Conclusion:

A focal defect of the mastoid bone shell overlying the transverse-sigmoid sinus, with no abnormality of the sinus itself, may be a new cause of pulsatile tinnitus. Surgical reconstruction of the mastoid bone shell overlying the transverse-sigmoid sinus can provide lasting symptom relief for patients with pulsatile tinnitus and computed tomographic evidence of the defect.

Delayed Progressive Extradural Pneumatocele due to Incomplete Sealing of Opened Mastoid Air Cell after Micro-Vascular Decompression

A case of delayed progressive extradural pneumatocele after microvascular decompression (MVD) is presented. A 60-year-old male underwent MVD for hemifacial spasm; the mastoid air cell was opened and sealed with bone wax during surgery. One month after surgery, the patient complained of tinnitus, and progressive extradural pneumatoceles without cerebrospinal fluid (CSF) leakage was observed. Revision surgery was performed and the opened mastoid air cell was completely sealed with muscle patch and glue. The patient's symptoms were resolved, with no recurrence of pneumatoceles at 6 month follow up. Progressive extradural pneumatocele without CSF leakage after posterior fossa surgery is a very rare complication. Previous reports and surgical management of this rare complication are discussed.

Arteriovenous malformation in the parotid region presenting as pulsatile tinnitus: a case report

BACKGROUND

Pulsatile tinnitus is a unique symptom in the general population and often leads patients to medical attention.

METHODS AND RESULTS

We report a patient who had an arteriovenous malformation of superficial temporal artery in the parotid region causing pulsatile tinnitus and insomnia. Magnetic resonance angiography and carotid angiography were useful tools for the detection of this vascular malformation. Successful treatment of this lesion was achieved by endovascular embolization.

CONCLUSION

This case illustrates a thorough diagnostic work-up with a high index of suspicion and a proper treatment option is rewarding when dealing with such a rare disease.

Subjective pulsatile tinnitus associated with extensive pneumatization of temporal bone

Pulsatile tinnitus (PT), a rare otologic symptom, is frequently associated with identifiable and treatable causes. We report two cases of subjective PT due to extensive pneumatization of temporal bone around the internal carotid artery.