How is pulsatile tinnitus investigated?
The doctor will start by taking a detailed history of the tinnitus and any other medical conditions that may affect the patient. The doctor will then examine the patient paying particular attention to the ear drums and the blood vessels of the neck.
A stethoscope may be used to listen to the neck and skull – if the doctor can hear a pulsatile noise through the stethoscope this is referred to as objective pulsatile tinnitus. Pulsatile tinnitus that cannot be heard by the doctor is called subjective pulsatile tinnitus. Patients with any form of tinnitus will have a series of hearing tests and pulsatile tinnitus is no different in this respect..
Patients with pulsatile tinnitus will generally then undergo some form of medical imaging. This has changed dramatically in recent years and a wider range of techniques are now available:
The doctor will start by taking a detailed history of the tinnitus and any other medical conditions that may affect the patient. The doctor will then examine the patient paying particular attention to the ear drums and the blood vessels of the neck.
A stethoscope may be used to listen to the neck and skull – if the doctor can hear a pulsatile noise through the stethoscope this is referred to as objective pulsatile tinnitus. Pulsatile tinnitus that cannot be heard by the doctor is called subjective pulsatile tinnitus. Patients with any form of tinnitus will have a series of hearing tests and pulsatile tinnitus is no different in this respect..
Patients with pulsatile tinnitus will generally then undergo some form of medical imaging. This has changed dramatically in recent years and a wider range of techniques are now available:
Ultrasound
This is a similar test to the scan performed on a pregnant woman. Modern ultrasound scanning uses a technique called Doppler, which can show the blood flow within vessels.
CT scanning
This uses computer controlled X-rays to generate X-ray –slices’ of the body.
Magnetic resonance scanning (MRI)
This produces similar pictures to CT scanning but uses magnetic fields rather than X-rays.
Magnetic resonance angiography (MRA)
Some MRI scanners can produce scans of flowing blood. This produces an image of inside of the artery or vein in which the blood is flowing and can show up irregularities or narrowings of the vessel.
Angiography
This is the old fashioned and time consuming way of looking at the inside of vessels by injecting contrast medium directly into the vessel under investigation and taking a conventional x-ray. It still produces clearer, more detailed pictures of vessels than any of the other techniques and therefore is still used in selected cases.
Other investigations
Blood tests may be needed in the investigation of pulsatile tinnitus. For example, a Full Blood Count (FBC) may be required to rule out anaemia or Thyroid Function Tests (TFTs) may be requested if an overactive thyroid gland is suspected. If benign intracranial hypertension is suspected, the doctor may ask for opinions from other doctors such as Ophthalmologists or Neurologists who may request their own specialised investigations.
Source: British Tinnitus Association
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