Purpose: This study aimed to report the author's 15-year experience with the systematic evaluation and treatment of patients with pulsatile tinnitus.
Methods: Between August 1981 and August 1996, 145 patients with pulsatile tinnitus were evaluated. The diagnostic protocol was individualized according to the clinical findings and included appropriate radiologic testing, ultrasonography studies, and lumbar puncture with cerebrospinal fluid pressure measurement. Treatment was directed toward the etiology of the tinnitus.
Results: Benign intracranial hypertension syndrome (pseudotumor cerebri) was the most common diagnosis (56 patients), followed by atherosclerotic carotid artery disease (24 patients) and glomus tumors (17 patients). In 13 patients, no specific diagnosis could be reached.
Conclusions: Thorough history and physical examination are the two most important factors in evaluating patients with pulsatile tinnitus. Evaluation should be individualized and may include radiologic testing, ultrasonography studies, and lumbar puncture with cerebrospinal fluid pressure measurements. The majority of patients have a treatable underlying etiology.