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Pulsatile tinnitus Volume 32, issue 4, July-August 2020

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Author
Hôpital Lariboisière, service de neuroradiologie, 2, rue Ambroise Paré, 75010 Paris, France
* Tirés à part

Pulsatile tinnitus is defined as a sound perceived synchronously with the patient's pulse. This type of tinnitus differs in every respect from non-pulsatile tinnitus, which is the most common type of tinnitus, but for which there is no curative treatment. Pulsatile tinnitus, on the other hand, has many causes that can often be treated mainly by endovascular approach. Exploration of pulsatile tinnitus should be undertaken in a specialized neuroradiology center. The clinical assessment is based on both auscultation of the skull and cervical areas and selective compression of the internal jugular vein and the common carotid artery homolateral to tinnitus looking for an interruption of the sound. The radiological workup should begin with a cerebral MRI scan exploring the intracranial vessels, arteries and veins. If MRI does not show the cause, the second exploration is a CT scan of the temporal bones and sometimes, angio CT of the supra-aortic vessels. The treatment depends on the isolated cause. The most common cause of pulsatile tinnitus is the stenosis of a lateral sinus, which may be treated by stenting. Any physician consulted by a patient suffering tinnitus should distinguish the non-pulsatile type from the pulsating type, because the management is completely different.