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Objective: Tinnitus is a common otologic symptom secondary to numerous etiologies such as noise exposure, otitis, Meniere’s disease, otosclerosis, trauma, medications, and presbycusis. Conclusion: Treating physicians need to have a very compassionate attitude towards these patients and statements such as “there is nothing that can be done” are very inappropriate and should be strongly condemned.
Pulsatile tinnitus (PT) originates from sounds produced by vascular structures within the cranial cavity, head and neck region and thoracic cavity, which are transmitted to the cochlea by bony and vascular structures. Atherosclerotic carotid artery disease (ACAD) is a common cause of PT in older than 50 years of age patients, especially when associated risk factors for atherosclerosis such as hypertension, angina, hyperlipidemia, diabetes mellitus, and smoking are present. Pseudotumor cerebri syndrome is a common cause of venous PT, especially in young and obese females. Pulsatile tinnitus in pseudotumor cerebri syndrome is believed to result from the systolic pulsations of the CSF originating mainly from the arteries of the Circle of Willis.
Idiopathic PT, essential PT and venous hum are terms used interchangeably to describe patients with PT of unclear etiology.
Myoclonic contractions of the tensor veli palatini, levator veli palatini, salpingopharyngeus and superior constrictor muscles can result in objective PT.
Myoclonus of the stapedial muscle has also been reported as a cause of pulsatile tinnitus (42).
Associated symptoms of hearing loss, aural fullness, dizziness, headaches and visual disturbances, such as visual loss, transient visual obscurations, retrobulbar pain and diplopia are suggestive of associated Pseudotumor cerebri syndrome (35,37). Older patients with history of cerebrovascular accident, transient ischemic attacks, hyperlipidemia, hypertension, diabetes mellitus and smoking should be suspected of having ACAD (36). Otoscopy is essential for the detection of middle ear pathology such as a high or exposed jugular bulb, aberrant carotid artery, and glomus tumor.
Auscultation of the ear canal, peri-auricular region, orbits, cervical region and chest is essential for detection of objective PT, bruits and heart murmurs. Pure tone (air and bone conduction) and speech audiometry should be performed in all patients. Complete blood count and thyroid function tests should be obtained in patients with increased cardiac output syndrome to exclude anemia and hyperthyroidism.
Duplex carotid ultrasound (including the subclavian arteries) and echocardiogram should be obtained in patients suspected of ACAD and valvular disease respectively (35).
Radiologic evaluation needs to be individualized according to the clinical presentation, physical and audiometric findings.
Pseudotumor cerebri syndrome patients should be treated for any associated disorders such as morbid obesity. Symptomatic high-dehisced jugular bulb can be repaired with pieces of cortical bone or cartilage (37). Ligation of the ipsilateral to the tinnitus IJV has been recommended in the literature for patients with idiopathic PT. Recent advances in tinnitus research have led to a better understanding and management of this common otologic symptom. National Center for Health Statistics: Basic data on hearing levels of adults 25-74 years, United States 1971-1975.
Sismanis A, Callari RH, Slomka WS, Butts FM: Auditory evoked responses in benign intracranial hypertension syndrome.
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Lifestyle Changes - tinnitus triggered or aggravated by stress, could be managed by seeking further support to deal with the cause of the stress.
Hearing Aids - those with hearing impairment may find that wearing a hearing aid can help mask their tinnitus via additional amplification. Sound Therapy - deliberate use of sound to reduce the perception or awareness of tinnitus or alleviate the distress associated with it can be classed as sound therapy.


Chill Kechil is our latest Les Paul Ambassador, helping to educate musicians and others about the risks of noise-induced hearing loss and tinnitus. I found out in high school through hearing tests that I had some high frequency hearing loss. As I began DJing and producing music, I became aware of many technology tools that help both protect and aid me in producing music. When composing and producing music, there are several applications that I’ve found helpful.
I also learned that, although human hearing technically ranges from 20 to 20,000 hertz (Hz), most people don’t fully hear the entire range, and in the higher and lower frequencies they may only be able to sense that there is a sound being made. Chill Kechil is donating a portion of his music and apparel proceeds to Hearing Health Foundation.
5581 Hudson Industrial Parkway, Hudson, OH 44236-0099 Order toll free 1-844-276-2020 © 2016 Support Plus. Based upon sound characteristics, tinnitus can be classified as non-pulsatile (or continuous) which is the most common type and pulsatile. Pulsatile tinnitus arises from either increased flow volume or stenosis of a vascular lumen.
This syndrome is characterized by increased intracranial pressure without focal signs for neurological dysfunction except for occasional fifth, sixth, and seventh cranial nerve palsies.
These pulsations, which are increased in magnitude in the presence of intracranial hypertension, are transmitted to the exposed medial aspect of the dural venous sinuses (transverse and sigmoid) compressing their walls synchronously with the arterial pulsations. A possible cause of idiopathic PT is believed to be turbulent blood flow produced in the IJV as it curves around the lateral process of the atlas (40).
These contractions can range between 10 and 240 per minute and may be confused with the arterial pulse. Rhythmic movements of the tympanic membrane can be present in patients with tensor tympani myoclonus. This should be performed in a quiet room, preferably with a modified electronic stethoscope. Serum lipid profile and fasting blood sugar should be requested in patients suspicious for ACAD.
Patients with a retrotympanic mass should have a high-resolution temporal bone computed tomography (CT) at their initial evaluation (47).
These patients responds well to weight reduction and medical management with Acetazolamide (Diamox). A thorough evaluation should be performed in all patients in order to accomplish accurate diagnosis and effective management.
Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. Treatment of tinnitus by intratympanic instillation of lignocaine (lidocaine) 2 per cent through ventilation tubes. Lidocaine test in patients with tinnitus: rationale of accomplishment and relation to the treatment with carbamazepine.
Effect of intratympanically administered gentamycin on hearing and tinnitus in Meniere’s disease. The usefulness of nimodipine, an L-calcium channel antagonist, in the treatment of tinnitus.
Otologic manifestations of benign intracranial hypertension syndrome: diagnosis and management. Benign intracranial hypertension without papilledema: Role of 24-hour cerebrospinal fluid pressure.
Sound therapy is one of the easiest things you can do for yourself if you don’t need professional help or are unable to access it.


Here, the New Jersey-based DJ and composer describes how he has managed his hearing loss while building a career in the music industry. This indicates whether there is too much or too little sound in low to high frequencies, allowing me to mix the music better for a better listening experience. A common practice in producing is to use filters to cancel and smooth out sounds below the lower and higher ends of the frequency spectrum. Instant Relief from Tinnitus MiseryThis non-invasive, handheld device stops the ringing and buzzing in your ears so you can focus on work, sleep, or just go about your day. Since these two types of tinnitus have very diverse etiologies, pathophysiology as well as treatment, they will be described as separate entities. Diagnosis of this condition should be made only after appropriate evaluation and elimination of other disorders, such as pseudotumor cerebri syndrome.
Myoclonic contractions of the soft palate can be present in patients with palatal myoclonus. Auscultation with an electronic stethoscope has been found more sensitive than traditional auscultation (45). If a glomus tympanicum, aberrant internal carotid artery, or jugular bulb abnormality is diagnosed, no other imaging studies are needed.
It is strongly recommended that this procedure be considered only after careful elimination of any other causes of PT, especially pseudotumor cerebri syndrome. There are a broad range of devices available on the market providing background noise to reduce the perception of tinnitus.
In particular, since my focus is on the high frequency areas, I use the visual EQ to monitor too much signal in that range. Read more about Chill Kechil in the upcoming Spring issue of Hearing Health magazine, out in April.
Turn on the wand and press the tip against your outer ear, Temporal bone, or ear cartilage. Venous PT type can originate not only from primary venous pathologies, but also from conditions causing increased intracranial pressure by transmission of arterial pulsations to the dural venous sinuses (35).
Wide opening of the oral cavity during examination may result in elimination of the soft palate contractions. When objective PT is detected, its rate should be compared to the patient’s arterial pulse. For patients with glomus jugulare tumors, CT examination of the neck also should be obtained to detect any possible synchronous chemodectomas along the carotid arteries.
Tensor tympani and stapedial myoclonus may respond to section of the respective muscles via tympanotomy (42). Mild tinnitus is common - about 10 per cent of the population have it all the time and, in up to one per cent of adults, this may affect the quality of their life. Micro-vibrations calm and soothe the Auditory Nerve while producing a "white noise" effect that mutes the ringing.
Pulsatile tinnitus secondary to the antihypertensive medications enalapril maleate or verapanil hydrochloride subsides soon after discontinuation of these agents (37).
This not only protects my hearing but also allows me to mix the next song in my headphones before playing them over the sound system to the audience.



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