Top Ten PULSATILE Tinnitus Tips For Doctors People with pulsatile -or pulse-synchronous- tinnitus hear a sound that is in sync with their heartbeat or pulse. Most commonly described as a “whooshing,” the sound can be heard on one or both sides. It is a symptom of an underlying disorder, rather than a disease unto itself. Unlike the more common form of constant tinnitus, in which a constant “ringing in the ears” tone is perceived, the underlying cause of pulsatile tinnitus may often be identified and treated. Pulsatile tinnitus is typically related to some kind of vascular process, rather than an implication of the ear apparatus itself. Pulsatile tinnitus may sound like a whooshing, swooshing, screeching, creaking, clicking or other rhythmic sound. The key that distinguishes the sound from “regular” tinnitus is that it is a pulsing sound that is in sync with the heart rate. Some describe it as a low pitch sound, like the sound of someone marching in the snow, and others describe a much higher, screeching sound, like the sound that birds sometimes make. Low or high, it is pulsatile tinnitus if it is in sync with the pulse. Pulsatile tinnitus, unlike constant tinnitus, is only rarely described as “ringing in the ears.” The differential diagnosis of pulsatile tinnitus is very different from its nonpulsatile counterpart, and its work-up is different as well. It is often possible to diagnose and remedy the underlying cause of pulsatile tinnitus. More than half of people with pulsatile tinnitus have an identifiable cause; it may be the sole symptom of a potentially dangerous condition. Pulsatile tinnitus warrants a thorough medical evaluation to look for known, identifiable and treatable causes, and to exclude the possibility of a worrisome problem. For these reasons, it is especially important for doctors to know how to recognize a patient who is experiencing pulsatile tinnitus, and to adequately distinguish and evaluate the patient’s symptoms, while also acknowledging the effects that such a symptom may have on a patient’s quality of life. This list provides helpful information for doctors to support a patient experiencing pulsatile tinnitus. We encourage patients who think they may be experiencing pulsatile tinnitus to review this information sheet with their doctors. Mo Fouladvand, M.D. Associate Professor Departments of Neurology & Ophthalmology NYU Langone Medical Center Jeffrey W. Olin, D.O. Professor of Medicine (Cardiology) Director of Vascular Medicine Zena and Michael A. Wiener Cardiovascular Institute & Marie-Josée and Henry R. Kravis Center for Cardiovascular Health Mount Sinai School of Medicine © 2012 Whooshers.com Maksim Shapiro, M.D. Assistant Professor Departments of Neurology & Radiology Division of Neurointerventional Radiology NYU Langone Medical Center Top Ten PULSATILE Tinnitus Tips For Doctors 1. PULSATILE TIN N ITUS, DEFIN ED AS TIN N ITUS SYN CHRO N O US W ITH THE HEARTBEAT, IS LESS CO M M O N THAN THE CO N STAN T SO UN D FO RM O F TIN N ITUS. IT IS USUALLY A SYM PTO M O F AN UN DERLYIN G PULSATILE PRO CESS, TYPICALLY VASCULAR IN N ATURE, RATHER THAN A PRO BLEM W ITH THE EAR APPARATUS ITSELF. 2. PULSATILE TIN N ITUS IS A SYM PTO M THAT AFFECTS M EN AN D W O M EN O F ALL AG ES AN D SIZES. 3. PULSATILE TIN N ITUS M AY M AN IFEST AS DIFFEREN T SO UN DS FO R DIFFEREN T PEO PLE, BUT IT RARELY IS A “RIN G IN G IN THE EARS,” AS REG UL AR TIN N ITUS IS O FTEN DESCRIBED. 4. PULSATILE TIN N ITUS M AY BE SUBJECTIVE (HEARD O N LY BY THE PATIEN T) O R O BJECTIVE (HEARD BY THE PATIEN T AN D O THERS). 5. A G EN ERAL PRACTIO N ER SHO ULD TRY TO LISTEN FO R A BRUIT (THE W HO O SHIN G SO UN D) W ITH THE BELL O F THE STETHO SCO PE AT THE AN G LE O F THE JAW , O VER THE M ASTO ID BO N E, AN D ARO UN D THE EAR, PREFERABLY IN A SO UN DPRO O F O R VERY Q UIET RO O M , TO DETERM IN E W HETHER THE PATIEN T’S PULSATILE TIN N ITUS IS O BJECTIVE O R SUBJECTIVE. 6. PO SSIBLE CAUSES O F PULSATILE TIN N ITUS IN CLUDE ARTERIAL N ARRO W IN G /O CCLUSIO N , TO RTUO SITY O R LO O PIN G O F THE CARO TID O R VERTEBRAL ARTERY, AN EURYSM , ARTERIO VEN O US FISTULA O R M ALFO RM ATIO N , VEN O US O CCLUSIVE DISEASE, M IDDLE EAR TUM O RS, AN D ELEVATED IN TRACRAN IAL PRESSURE, AM O N G O THERS. M AN Y O F THESE ARE PO TEN TIALLY DAN G ERO US CO N DITIO N S. A PATIEN T EXPERIEN CIN G PULSATILE TIN N ITUS SHO ULD UN DERG O A THO RO UG H M EDICAL EVALUATIO N , AN D M AY REQ UIRE CO N SULTATIO N S BY A VARIETY O F SPECIALISTS, DEPEN DIN G O N SPECIFIC SYM PTO M S. 7. THERE IS N O SIN G LE BEST DIAG N O STIC M O DALITY THAT CAN ESTABLISH A CAUSE O F PULSATILE TIN N ITUS, AN D M AN Y PATIEN TS M AY UN DERG O M ULTIPLE TESTS. SO M E TESTS TO EVALUATE THE CIRCULATIO N IN CLUDE CT AN G IO G RAPHY, M R AN G IO G RAPHY AN D DUPLEX ULTRASO UN D. THESE IM AG IN G M O DALITIES M AY VISUALIZE THE ARTERIES AN D V EIN S. 8. IT IS N O T CO M M O N FO R PULSA TILE TIN N ITUS TO G O AW AY O N ITS O W N . 9. M AN Y PATIEN TS HAVE DIFFICULTY EN DURIN G PULSATILE TIN N ITUS, W HICH O FTEN LEADS TO IN SO M N IA, LO SS O F CO N CEN TRATIO N , AN D PRO FO UN D AN XIETY. HEARIN G AIDS O R M ASKIN G DEVICES, AM O N G O THER M ETHO DS, M AY BE USED AS CO PIN G TO O LS, BUT N O T AS “CURES.” 10. PULSATILE TIN N ITUS HAS M AN Y PSEUDO N YM S (E.G . PULSE-SYN CHRO N O US TIN N ITUS; VASCULAR TIN N ITUS; BRUIT; M ACHIN ERY M URM UR, ETC.). IN CLUDE THESE TERM S IN YO UR SEARCH W HEN REVIEW IN G M EDICAL REPO RTS. ADDITIONAL INFORMATION AND SUPPORT FOR PULSATILE TINNITUS PATIENTS AND THEIR DOCTORS Whooshers.com is an information and support site for people who experience pulsatile tinnitus. Provided are links to medical reports, along with personal accounts from real “Whooshers” that describe pulsatile tinnitus experiences, diagnoses, and, in a growing number of cases, treatments. Patients should review the information and links to medical reports with their doctors; doctors are encouraged to compare the details in medical reports to the symptoms presented by their patients. Pulsatile tinnitus is a symptom to be taken seriously by medical professionals familiar with the long list of possible underlying causes; self-diagnosis by patients is, as always, strongly discouraged. © 2012 Whooshers.com