Sound Measurements in Pulsatile Tinnitus: A Review in 171 Patients

OBJECTIVE: To evaluate the diagnostic application of external ear canal sound measurements in pulsatile tinnitus (PT).

STUDY DESIGN: Retrospective chart review on a prospective series of sound measurements.

SETTING: Tertiary referral center.

PATIENTS: A cohort of 171 PT patients with sound measurements during diagnostic workup for PT (2016-2023).

MAIN OUTCOME MEASURE: The percentages of PT patients per pathology and diagnosis, with PT objectified by sound measurements.

RESULTS: In 57% of the patients, an identifiable etiology that could explain the PT was identified using various imaging modalities. The PT could be detected with a sound measurement in the ear canal in 48% of these patients. In absence of an identifiable etiology, an objective PT was found in only 15% of the cases. PT was more often detected for patients with arterial pathologies than venous or nonvascular pathologies (73% vs 50% and 22%, respectively). Particularly, in PT patients with a DAVF, an objective PT was found for all patients (100%). The sound measurements were found to be more sensitive than auscultation in detecting bruits in PT patients.

CONCLUSION: A sound recording can objectify PT in almost half of the cases with a diagnosis as determined by imaging. In patients where the PT cannot be detected, arterial pathologies (particularly DAVFs) are less likely. Combined with a thorough clinical evaluation and proper imaging studies, sound measurements can be of added value in the clinical pathway of PT patients.