Pulsatile Tinnitus: A Good Reason for Thorough Ear, Nose, Throat Investigation

Background and Aim: Tinnitus is a frequent and sometimes very annoying symptom. However, pulsatile tinnitus (rhythmic and synchronous with the patient's heartbeat) is relatively rare. Moreover, it may present as a serious diagnostic problem or even a medical emergency. The cause of pulsatile tinnitus may be suspected on otoscopic examination, and CT/MRI scans or MRI angiography may be needed in the differential diagnosis. The main objective is to exclude a vascular lesion (glomus, aneurism, etc).

Case Reports: We report three cases of pulsatile tinnitus, which were investigated in our hospital. The physical examination and modern imaging revealed glomus tumors in all cases. Case 1 involved a 45-year-old, woman who complained of a pulsating tinnitus in her left ear and ipsilateral hearing loss for the last 2 years. Otoscopy revealed a retrotympanic purple tumor. The pure tone audiogram showed a conductive-type hearing loss. The CT scan revealed a glomus tympanicum on the promontory, with a diameter less than 1 cm. Case 2 was a 55-year-old woman who complained of pulsating tinnitus in her right ear with ipsilateral hearing loss for the last 3 years. Otoscopy revealed a retrotympanic purple tumor. The pure tone audiogram showed a mixed-type hearing loss. The CT scan revealed a glomus tympanicum on the promontory, with a diameter of approximately 1 cm. Case 3 was a 37-year-old man who came to our clinic complaining of pulsating tinnitus, hoarse voice, and dysphagia. Otoscopy showed a retrotympanic red tumor. The pure tone audiogram revealed a mixed-type hearing loss, and the CT scan showed a glomus jugulotympanicum pressing the cranial nerves that pass through the jugular foramen. All patients had surgical treatment with satisfactory results.

Conclusion: The differential diagnosis and management of pulsatile tinnitus may be quite challenging. Glomus tympanicum and jugulotympanicum should always be in mind, although other vascular lesions and other diseases should be taken into account as well.