An integrated program designed for patients with pulsatile tinnitus promises to bring relief to thousands of sufferers
The Weill Cornell Medicine Brain and Spine Center, along with expert physicians from the departments of Otolaryngology (ENT), Ophthalmology, and Neurology have introduced a new multidisciplinary program created specifically for patients with pulsatile tinnitus. The multidisciplinary program will provide integrated treatment for pulsatile tinnitus, which can have several different causes.
Neurosurgeons and interventional radiologists will collaborate with Dr. George Alexiades and Dr. Maria Suurna from ENT, Dr. Marc Dinkin and Dr. Cristiano Oliveira from Ophthalmology, and Dr. Neal Parikh from Neurology to offer expert diagnosis and treatments ranging from embolization, surgery, and the minimally invasive venous sinus stenting procedure recently shown to be remarkably effective in treating pulsatile tinnitus.
Pulsatile tinnitus is a condition that causes an individual to hear a rhythmic sound in sync with the heartbeat. It is often described as a “whooshing” sound that can range from distracting to maddening, and patients are often told (erroneously) that there is no cure. The underlying cause of the pulsatile tinnitus is also variable; it may be caused by several different conditions, ranging from benign to life-threatening, so evaluation and workup by experts are extremely important. Depending on the underlying cause of the tinnitus, there may be solutions that can provide relief.
“Pulsatile tinnitus is a condition that receives very little attention in the medical field,” says Dr. Stieg, neurosurgeon-in-chief and director of the WCM Brain and Spine Center. “Patients with pulsatile tinnitus are often dismissed by their doctors, but they deserve workup for a variety of possible causes.
CAUSES
The causes of PT are different from the causes of non-pulsatile tinnitus (also called continuous or ringing tinnitus).
Vascular Causes
The most common conditions that cause pulsatile tinnitus are vascular, meaning they are related to the blood vessels in the brain. One of the most concerning causes of pulsatile tinnitus are intracranial abnormalities called arteriovenous shunts, which can be subcategorized as dural arteriovenous fistulas (DAVFs) and intracranial arteriovenous malformations (AVMs). The DAVFs are much more common in patients with pulsatile tinnitus and may cause brain dysfunction, including brain bleed. Therefore they should be detected early and treated if necessary.
Another common and often elusive cause of pulsatile tinnitus is a narrowing of the large veins adjacent to the ear, a condition called venous sinus stenosis.
Narrowing of the arteries of the head or the neck near the ear may also cause pulsatile tinnitus.
ENT Disorders
Benign tumors called paragangliomas can cause pulsatile tinnitus due to their vascular nature. These tumors often require treatment with surgery or radiation. Eustachian tube dysfunction can be infrequently associated with pulsatile tinnitus as well.
Neurological Disorders
Pulsatile tinnitus can result from muscle spasm of one of the muscles within the ear, or from myoclonus of the palatial muscles. These conditions may be related to underlying neurologic abnormality.
Other Causes
A dysfunction of the temporomandibular joint (commonly referred to as TMJ) may also cause both pulsatile tinnitus and non-pulsatile tinnitus.
DIAGNOSIS AND WORK-UP
The Pulsatile Tinnitus Program at the Weill Cornell Medicine Brain and Spine Center aims to offer patients a path for diagnosis and treatment of this condition. “There are two key elements in this effort,” says Dr. Stieg. “The first is that we offer a multi-disciplinary approach, which is necessary to achieve the highest level of care. The second is that we do most of the evaluation with state-of-the-art, non-invasive imaging – we reserve invasive tests only for those instances when they are absolutely necessary.”
At Weill Cornell Medicine, patients with PT are evaluated with specialized MRI scans that are specifically designed to identify vascular problems from the arteries and veins adjacent to the ear.
Patients may also need additional imaging to identify tumors or problems in the temporal bone and the ear structures, as well as audiometry and tympanometry. Additional testing may be needed after the initial work-up.
One of the advanced treatments that have been pioneered at Weill Cornell Medicine is venous sinus stenting. Many patients with pulsatile tinnitus are found to have a narrowing in the large veins of the brain. This is often associated with expansion of the vein past the stenosis, a condition called venous diverticula. The combination of narrowing and expansion of the vein causes turbulent flow adjacent to the ear, resulting in pulsatile tinnitus.
The first clinical trial on venous sinus stenting for pulsatile tinnitus is being conducted at Weill Cornell Medicine with excellent outcomes. The results will be published in academic journals soon.
The team at the Pulsatile Tinnitus Program at Weill Cornell Medicine is dedicated to offering patients the best possible care and outcomes. For further information and appointments please contact Dr. Srikanth Boddu or use our online form to request an appointment.
