In certain groups of individuals with tinnitus, it is important to image the head and neck to exclude an organic cause for their symptoms. The role of imaging is to detect specific pathology that is treatable. A variety of imaging modalities may be considered depending on the type of tinnitus and/or associated symptoms reported, particularly if the tinnitus is considered to be pulsatile in nature. Imaging modalities include ultrasound, computerised tomography, magnetic resonance imaging and angiography. A thorough history and clinical examination can direct the decision for imaging and the type of imaging.
Pulsatile tinnitus is heard as a regular rhythmical noise. It can occur at the same time as the heart beat (synchronous) or at a different interval (non-synchronous). Synchronous pulsatile tinnitus can be caused by a number of different causes such as irregular blood vessels, high blood pressure, raised intracranial pressure, anaemia and atherosclerosis. Vascular causes may be systemic, for example anaemia, or due to a vascular anomalies or pathology, for example arteriovenous malformation or fistula. Non-vascular pulsatile causes include paragangliomas, intracranial hypertension, osseous pathology and somatic causes. Middle ear pathology such as glomus tumours can also give rise to synchronous tinnitus. Non-synchronous pulsatile tinnitus may be caused by palatal myoclonus. If these conditions are identified they can then be treated, which should also improve the tinnitus.
Whilst it is crucial not to miss significant pathology, it is also important not to over-scan people where significant pathology is unlikely. Not only is this cost unnecessary, it maybe unpleasant and stressful for the person and possibly expose them to an unnecessary dose of ionising radiation or risk of adverse effects from the contrast agent.
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