HSC Section 8_April 2017

G. Madani, S.E.J. Connor

Causes of pulsatile tinnitus

Table 2

Arterial

Arterial anomalies Aberrant internal carotid artery a Persistent stapedial artery Neurovascular contact

Arteriopathy

Atherosclerosis Fibromuscular dysplasia

Internal carotid artery dissection Aneurysms

Vascular tumours Paraganglioma a Endolymphatic sac tumour Meningioma

Haemangipericytoma Vascular metastases Haemangioma

Bone dyplasias Otospongiosis

a study of 100 consecutive patients with cerebro- vascular disease, 29% suffered from PT. 13 Those with PT were more likely to have severe (greater than 70%) stenosis, complete occlusion, or ICA dis- ease ( Fig. 5 ). 13 Daneshi et al. 14 investigated Transverse CT image demonstrates an aber- rant left ICA. The focal projection laterally (arrowhead) corresponds to a pseudoaneurysm at the site of previous middle ear exploration. Figure 2

Paget’s disease

Intrameatal vascular loops

Vascular malformations and fistulae

Venous

Venous anomalies High-riding or dehiscent jugular bulb a Aberrant sigmoid sinus Venous sinus thrombosis Abnormal emissary vains

Benign intracranial hypertension

Non-vascular

Myoclonus (palatal, tensor tympani, stapedius)

Chronic middle-ear disease Dehiscent semicircular canal a Evident at otoscopy as retro/intratympanic mass.

nature of glomus tumours accounts for the classic ‘‘salt and pepper’’ appearance on T2 and con- trast-enhanced T1-weighted MRI resulting from multiple flow voids against a T2 hyperintense or enhancing stroma. Hypervascularity is demon- strated at angiography ( Fig. 4 ).

Figure 3 Transverse CTA/V image demonstrating a large glomus jugulotympanicum in a patient who pre- sented with PT (who had previously undergone resection of a large glomus vagale tumour). There is erosion of the left jugular fossa up to the horizontal portion of the ca- rotid canal and of the cochlear promontory. Enhancing tissue fills the jugular foramen extending to the petrous apex (black arrow) and middle ear (white arrow).

Arterial tinnitus

Arteriopathy

Atherosclerosis is one of the more common causes of PT, accounting for 8 e 20% of cases ( Table 1 ). In

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