Transcanal sound recordings as a screening tool in the clinical management of patients with pulsatile tinnitus. A pilot study of twenty patients with pulsatile tinnitus eligible for digital subtraction angiography

Abstract

In pulsatile tinnitus, the differential diagnosis includes neurovascular pathology, which can be occult on non‐invasive imaging techniques. Therefore, if a clear diagnosis is lacking, digital subtraction angiography (DSA) is indicated to rule out a potentially hazardous vascular lesion, particularly a dural arteriovenous fistula (dAVF). However, a DSA carries a procedural risk of 1‐2%.

In a tertiary care setting, the incidence of a dAVF in pulsatile tinnitus patients lacking a diagnosis after non‐invasive imaging is about 25‐35%. Therefore, the majority of this group of patients is unnecessarily exposed to the risks of DSA.

We report on 20 consecutive patients in a tertiary care setting with pulsatile tinnitus who were referred for DSA to rule out neurovascular pathology. We found that the absence of a pulsatile sound detected by transcanal sound recordings, excludes a dAVF (100% sensitivity).

Consequently, the use of transcanal sound recordings as a screening tool may prevent patients for the unnecessary risks of DSA in the diagnostic work‐up of pulsatile tinnitus.

Conventional peri‐auriculair and neck auscultation with stethoscope is not always sufficient to objectify the presence of a pulsatile tinnitus.

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