Tinnitus

Q: Which of the following forms of tinnitus raises more concern for underlying significant pathology? - select one

A) pulsatile 

B) non-pulsatile

Answer: A

The objective of this question is to emphasize the importance of thorough history taking and physical examination skills, an art that is rapidly vanishing from clinical practice.

Tinnitus is a perception of sound in proximity to head in the absence of an external source. It is a common presenting symptom from outpatient to ICU. It can be presented in various forms, such as being within one or both ears, within or around the head, or as an outside, distinct noise. It can be a buzzing, ringing, hissing, or any other noise. Two crucial aspects of tinnitus that raise the concern for underlying significant pathology are

• continuous 
• pulsatile 

If the sound of Tinnitus is intermittent and/or non-pulsatile, the likelihood is that it is not related to a serious underlying pathology. Said that all symptoms should be appropriately evaluated, as symptoms sometimes can be more distressing to the patient than the sign! It is important to 'heal' the patient and not to treat the sign!

#neurology

Further reads:

1. Narsinh KH, Hui F, Saloner D, Tu-Chan A, Sharon J, Rauschecker AM, Safoora F, Shah V, Meisel K, Amans MR. Diagnostic Approach to Pulsatile Tinnitus: A Narrative Review. JAMA Otolaryngol Head Neck Surg. 2022 May 1;148(5):476-483. doi: 10.1001/jamaoto.2021.4470. PMID: 35201283.

2. Park KW, Kullar P, Malhotra C, Stankovic KM. Current and Emerging Therapies for Chronic Subjective Tinnitus. J Clin Med. 2023 Oct 16;12(20):6555. doi: 10.3390/jcm12206555. PMID: 37892692; PMCID: PMC10607630.

3. Dalrymple SN, Lewis SH, Philman S. Tinnitus: Diagnosis and Management. Am Fam Physician. 2021 Jun 1;103(11):663-671. PMID: 34060792.