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E1966. Terrible Ringing in the Ears: Imaging in Pulsatile Tinnitus
Authors
  1. Shivaprakash Hiremath; The Ottawa Hospital
  2. Nader Zakhari; The Ottawa Hospital
  3. Marlise dos Santos; The Ottawa Hospital
  4. Santanu Chakraborty; The Ottawa Hospital
Background
Tinnitus is an auditory perception of a whooshing sound in the ears that may affect about 15-20% of the population. It can be either objective or subjective, caused by arterial, arteriovenous, or venous anatomical variations or pathologies of the central nervous system. The primary purpose of this educational exhibit is to describe and guide the imaging protocols for the diagnostic work-up of pulsatile tinnitus based on clinical presentation and findings of physical examination. Our secondary purpose is to present the imaging findings in the vascular, neoplastic, and osseous conditions and pathologies that cause pulsatile tinnitus.

Educational Goals / Teaching Points
a. To review imaging strategies based on clinical presentation and physical examination. b. To illustrate the imaging findings in the vascular, neoplastic, and osseous pathologies associated with pulsatile tinnitus. c. To highlight the implications of the imaging findings and possible etiologies in the clinical management and prognosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The clinical findings influence the strategy of imaging investigation in patients with pulsatile tinnitus. The illustrated pathologies resulting in pulsatile tinnitus are classified into arterial (anatomical variants and steno-occlusive pathologies), arteriovenous (arteriovenous fistulae and malformations), and venous (idiopathic intracranial hypertension, osseous and neoplastic lesions) etiologies. We highlight the role of imaging findings in the management and the prognosis of myriad etiologies resulting in pulsatile tinnitus.

Conclusion
Pulsatile tinnitus may result in significant morbidity. Identification of the underlying cause is essential for optimal therapeutic management and prognosis. The choice of diagnostic modality depends on the estimated chance of finding an imaging abnormality based on the clinical history and physical examination. An adequate imaging strategy aids in the diagnosis of an underlying cause in the majority of patients with pulsatile tinnitus.