Skip to main content
SpringerLink
Log in

The Mechanism of Pulsatile Tinnitus and Treatment

  • Chapter
  • First Online:
Biomechanics of Injury and Prevention

  • 452 Accesses

Abstract

Pulsatile tinnitus (PT), a common otology symptom, is synchronous with patient’s heartbeat. PT is generally objective, induced by cranial vascular sound, and its mechanism is a biomechanical problem. Multiple etiologies and treatments were proposed in clinical studies, but without quantitative analysis in view of biomechanics. In this chapter, both numerical and experimental models were developed for quantification of generation, propagation and reception of PT sound in view of biomechanics. Based on these models, two commonly reported etiologies were analyzed, including sigmoid sinus cortical plate dehiscence/thinness and hyperpneumatization of temporal bone air cells. It is indicated in results that dehiscence of sigmoid sinus cortical plate would directly induce PT, while thinness would not. Normal pneumatization temporal bone cavity would amplify PT sound mostly, but the pneumatization grade would not be the direct etiology of PT. Based on the findings, we propose that PT patients with sigmoid sinus cortical plate dehiscence undergo plate resurfacing surgery, while the patients with thinness should not receive resurfacing surgery. For patients with only hyperpneumatization shown in radiology data, other etiologies should be searched and considered.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Walker DD, Cifu AS, Gluth MB (2016) Tinnitus. J Am Med Assoc 315(20):2221–2222

    Article  CAS  Google Scholar 

  2. Xenellis J, Nikolopoulos TP, Felekis D, Tzangaroulakis A (2005) Pulsatile tinnitus: a review of the literature and an unusual case of iatrogenic pneumocephalus causing pulsatile tinnitus. Otol Neurotol 26(6):1149–1151

    Article  PubMed  Google Scholar 

  3. Pridmore S, Walter G, Friedland P (2012) Tinnitus and suicide: recent cases on the public record give cause for reconsideration. Otolaryngology Head and Neck Surgery 147(2):193–195

    Article  PubMed  Google Scholar 

  4. Herraiz C, Aparicio JM (2007) Diagnostic clues in pulsatile tinnitus (Somatosounds). Acta Otorrinolaringologica (English Edition) 58(9):426–433

    Article  Google Scholar 

  5. Han L, Pengfei Z, Zhaohui L, Fei Y, Ting L, Cheng D, Zhenchang W (2015) Resting-state functional connectivity density mapping of etiology confirmed unilateral pulsatile tinnitus patients: altered functional hubs in the early stage of disease. Neuroscience 310:27–37

    Article  CAS  PubMed  Google Scholar 

  6. McFerran DJ, Phillips JS (2007) Tinnitus. J Laryngol Otol 121(3):201–208

    Article  CAS  PubMed  Google Scholar 

  7. Sila CA, Furlan AJ, Little JR (1987) Pulsatile tinnitus. Stroke 18(1):252–256

    Article  CAS  PubMed  Google Scholar 

  8. Valluru K, Parkhill J, Gautam A, Haraldsson H, Kao E, Leach J, Wright A, Ballweber M, Meisel K, Saloner D, Amans M (2020) Sound measurement in patient-specific 3D printed bench models of venous pulsatile tinnitus. Otol Neurotol 41(1):e7–e14

    Article  PubMed  PubMed Central  Google Scholar 

  9. Song JJ, An GS, Choi I, De RD, Kim SY, Choi HS, Park JH, Choi BY, Koo JW, Lee K (2016) Objectification and differential diagnosis of vascular pulsatile tinnitus by transcanal sound recording and spectrotemporal analysis: a preliminary study. Otol Neurotol 37(6):613–620

    Article  PubMed  Google Scholar 

  10. Kim SH, An GS, Choi I, Lee K, Song JJ (2016) Pre-treatment objective diagnosis and post-treatment outcome evaluation in patients with vascular pulsatile tinnitus using transcanal recording and spectro-temporal analysis. PLoS One 11(6):e0157722

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Sismanis A (2011) Pulsatile tinnitus: contemporary assessment and management. Curr Opin Otolaryngol Head Neck Surg 19(5):348–357

    Article  PubMed  Google Scholar 

  12. Weissman JL, Hirsch BE (2000) Imaging of tinnitus: a review. Radiology 216(2):342–349

    Article  CAS  PubMed  Google Scholar 

  13. Ahsan SF, Seidman M, Yaremchuk K (2015) What is the best imaging modality in evaluating patients with unilateral pulsatile tinnitus? Laryngoscope 125(2):284–285

    Article  PubMed  Google Scholar 

  14. Boddu S, Dinkin M, Suurna M, Hannsgen K, Bui X, Patsalides A (2016) Resolution of pulsatile tinnitus after venous sinus stenting in patients with idiopathic intracranial hypertension. PLoS One 11(10):e0164466

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Sonmez G, Basekim CC, Ozturk E, Gungor A, Kizilkaya E (2007) Imaging of pulsatile tinnitus: a review of 74 patients. Clin Imaging 31(2):102–108

    Article  PubMed  Google Scholar 

  16. Lansley JA, Tucker W, Eriksen MR, Riordan-Eva P, Connor SEJ (2017) Sigmoid sinus diverticulum, dehiscence, and venous sinus stenosis: potential causes of pulsatile tinnitus in patients with idiopathic intracranial hypertension? Am J Neuroradiol 38(9):1783–1788

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Liu Z, Chen C, Wang Z, Gong S, Xian J, Wang Y, Liang X, Ma X, Li Y (2013) Sigmoid sinus diverticulum and pulsatile tinnitus: analysis of CT scans from 15 cases. Acta Radiol 54(7):812–816

    Article  PubMed  Google Scholar 

  18. Mundada P, Singh A, Lingam RK (2015) CT arteriography and venography in the evaluation of pulsatile tinnitus with normal otoscopic examination. Laryngoscope 125(4):979–984

    Article  PubMed  Google Scholar 

  19. Zhao PF, Han L, Cheng D, Niu YT, Xian JF, Wang ZC (2016) CT evaluation of sigmoid plate dehiscence causing pulsatile tinnitus. Eur Radiol 26(1):9–14

    Article  PubMed  Google Scholar 

  20. Tüz M, Doğru H, Yeşildağ A (2003) Subjective pulsatile tinnitus associated with extensive pneumatization of temporal bone. Auris Nasus Larynx 30(2):183–185

    Article  PubMed  Google Scholar 

  21. Topal O, Erbek SS, Erbek S, Ozluoglu LN (2008) Subjective pulsatile tinnitus associated with extensive pneumatization of temporal bone. Eur Arch Otorhinolaryngol 30(1):183–185

    Google Scholar 

  22. Waldvogel D, Mattle HP, Sturzenegger M, Schroth G (1998) Pulsatile tinnitus—a review of 84 patients. J Neurol 245(3):137–142

    Article  CAS  PubMed  Google Scholar 

  23. Liu GS, Boursiquot BC, Blevins NH, Vaisbuch Y (2019) Systematic review of temporal bone–resurfacing techniques for pulsatile tinnitus associated with vascular wall anomalies. Otolaryngol Head Neck Surg 160(5):749–761

    Article  PubMed  Google Scholar 

  24. Krishnan A, Mattox DE, Fountain AJ, Hudgins PA (2006) CT arteriography and venography in pulsatile tinnitus: preliminary results. Am J Neuroradiol 27(8):1635–1638

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Tian S, Wang L, Yang J, Mao R, Liu Z, Fan Y (2017) Sigmoid sinus cortical plate dehiscence induces pulsatile tinnitus through amplifying sigmoid sinus venous sound. J Biomech 52:68–73

    Article  PubMed  Google Scholar 

  26. Lee SE, Lee S-W, Fischer PF, Bassiouny HS, Loth F (2008) Direct numerical simulation of transitional flow in a stenosed carotid bifurcation. J Biomech 41(11):2551–2561

    Article  PubMed  PubMed Central  Google Scholar 

  27. Morse RP (2013) The effect of flying and low humidity on the admittance of the tympanic membrane and middle ear system. J Assoc Res Otolaryngol 14(5):623–633

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tian S, Fan X, Wang Y, Liu Z, Wang L (2019) An in vitro experimental study on the relationship between pulsatile tinnitus and the dehiscence/thinness of sigmoid sinus cortical plate. J Biomech 84:197–203

    Article  PubMed  Google Scholar 

  29. Kim SH, An GS, Choi I, Koo JW, Lee K, Song JJ (2016) Pre-treatment objective diagnosis and post-treatment outcome evaluation in patients with vascular pulsatile tinnitus using Transcanal recording and Spectro-temporal analysis. PLoS One 11(6):e0157722

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Song JJ, An GS, Choi I, De Ridder D, Kim SY, Choi HS, Park JH, Choi BY, Koo J-W, Lee K (2016) Objectification and differential diagnosis of vascular pulsatile tinnitus by Transcanal sound recording and Spectrotemporal analysis. Otol Neurotol 37(6):613–620

    Article  PubMed  Google Scholar 

  31. Li B, Cao X, Liu X, Li S, Wang J, Liang Y, Ge A, Zhang A, Feng H (2014) Interventionai diagnosis and treatment of Vasculogeneic pulsatile tinnitus. Journal of Otology 9(1):7–15

    Article  CAS  Google Scholar 

  32. Eisenman DJ (2011) Sinus wall reconstruction for sigmoid sinus diverticulum and dehiscence: a standardized surgical procedure for a range of radiographic findings. Otol Neurotol 32(7):1116–1119

    Article  PubMed  Google Scholar 

  33. Maria PLS (2013) Sigmoid sinus dehiscence resurfacing as treatment for pulsatile tinnitus. Journal of Laryngology & Otology 127 Suppl 2(S2):1–3

    Google Scholar 

  34. Raghavan XP, Serulle XY, Gandhi XD, Morales XR, Quinn XK (2015) Postoperative imaging findings following sigmoid Sinus Wall reconstruction for pulse synchronous tinnitus. Am J Neuroradiol 37(1):136–142

    Article  PubMed  Google Scholar 

  35. Xue J, Li T, Sun X, Liu Y (2012) Focal defect of mastoid bone shell in the region of the transverse-sigmoid junction: a new cause of pulsatile tinnitus. Journal of Laryngology & Otology 126(4):409–413

    Article  CAS  Google Scholar 

  36. Al-Esawi S, Hasan A, Takhtani D, Hussain S (2017) Temporal bone hyperpneumatization and tinnitus: clinico-radiological evaluation using CT scan. Journal of global. Radiology 3(1):Article 5

    Google Scholar 

  37. Liu ZH, Gong SS, Long H, Pengfei Z, Zhenchang W, Guopeng W, Junfang X, XIaobo M, Yi L (2012) CT study of pneumatization of the temporal bone in cases with pulsatile tinnitus caused by sigmoid sinus abnormalities. Chinese Archives of Otolaryngology-Head and Neck Surgery 3(6):410–414

    Google Scholar 

  38. Liu W, Liu Z, Zheng N, Zhao P, Dong C (2015) Wang Z (2015) temporal bone pneumatization and pulsatile tinnitus caused by sigmoid sinus diverticulum and/or dehiscence. Biomed Res Int

    Google Scholar 

  39. Dong C, Zhao P, Liu Z, Xu W, Wang Z (2016) Association between the extent of sigmoid sinus dehiscence and an occurrence of pulsatile tinnitus: a retrospective imaging study. Clin Radiol 71(9)

    Google Scholar 

  40. Schoeff S, Nicholas B, Mukherjee S, Kesser BW (2014) Imaging prevalence of sigmoid sinus dehiscence among patients with and without pulsatile tinnitus. Otolaryngol Head Neck Surg 150(5):841–846

    Article  PubMed  Google Scholar 

  41. Song JJ, Kim YJ, Kim SY, An YS, Kim K, Lee SY, Koo JW (2015) Sinus wall resurfacing for patients with temporal bone venous sinus diverticulum and ipsilateral pulsatile tinnitus. Neurosurgery 77(5):709–717

    Article  PubMed  Google Scholar 

  42. Grewal AK, Kim HY, Comstock RH III, Berkowitz F, Kim HJ, Jay AK (2014) Clinical presentation and imaging findings in patients with pulsatile tinnitus and sigmoid sinus diverticulum/dehiscence. Otol Neurotol 35(1):16–21

    Article  PubMed  Google Scholar 

  43. Santa Maria P (2013) Sigmoid sinus dehiscence resurfacing as treatment for pulsatile tinnitus. The Journal of Laryngology & Otology 127(S2):S57–S59

    Article  Google Scholar 

  44. Hofmann E, Behr R, Neumann-Haefelin T, Schwager K (2013) Pulsatile tinnitus: imaging and differential diagnosis. Dtsch Arztebl Int 110(26):451

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Key Laboratory of Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China

    Shan Tian & Lizhen Wang

  2. Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China

    Zhaohui Liu

  3. Key Laboratory of Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China

    Yubo Fan

Authors
  1. Shan Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lizhen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhaohui Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yubo Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yubo Fan .

Editor information

Editors and Affiliations

  1. Key Laboratory of Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China

    Yubo Fan

  2. Key Laboratory of Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China

    Lizhen Wang

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tian, S., Wang, L., Liu, Z., Fan, Y. (2022). The Mechanism of Pulsatile Tinnitus and Treatment. In: Fan, Y., Wang, L. (eds) Biomechanics of Injury and Prevention. Springer, Singapore. https://doi.org/10.1007/978-981-16-4269-2_6

Download citation

Publish with us

Policies and ethics

Search

Navigation