Venous Pulsatile Tinnitus: Turbulence or Dehiscence?

Excerpt

Pulsatile tinnitus (PT) is defined as the perception of a sound in the absence of external stimulus, synchronous with the heartbeat [1]. It may have a venous origin when the sound is generated by the venous flow near the inner ear. Clinical examination is crucial, indeed the sound perceived by the patient is interrupted by compression of the internal jugular vein on the side of the PT. The most common cause of venous PT is stenosis of a lateral sinus [2]. In this case, PT is explained by the turbulences of the venous flow following its acceleration at the level of the stenosis [3]. Other causes have been identified, such as aneurysm of the sigmoid sinus [4], dehiscence of the lateral sinus [5] and dehiscence of a mastoid emissary vein into a mastoid cell [6]. In the latter causes, PT is explained by the excessive transmission of normal venous flow to the inner ear due to a loss of the bony envelope. Recently, diploic vein (DV) dehiscence has been identified as a new cause of venous PT treated by surgical ligation of the DV [7]. Here we report the second case of venous PT by dehiscence of a DV in a mastoid cell with the first reported endovascular treatment. …