Table 1:

Origin, common causes and management of pulsatile tinnitus⁴

Origin	Cause	Clinical findings	Management
Arterial	Atherosclerosis of the carotid artery	Risk factors for atherosclerosis	Carotid endarterectomy or stent
		Ipsilateral carotid bruit or thrill heard in patient’s neck
	Arteriovenous fistula and arteriovenous malformation	History of trauma, surgery, infection or intracranial neoplasm	Selective embolization
		Bruit auscultated over skull in the area behind the ear
		Pulsating rhythm of bruit similar to patient’s pulse
	Aberrant carotid artery	Otoscopy shows a beefy red mass behind the anteroinferior quadrant of the tympanic membrane	Reassurance
Venous	Benign intracranial hypertension	Typically seen in young female patients with morbid obesity	Reduction in weight; diuretics
		Headache, blurred vision, papilledema and other features of increased intracranial pressure without localizing neurological dysfunction
	Venous hum and high-riding jugular bulb	Tinnitus resolves with digital pressure applied over the internal juglar vein	Reassurance
		Otoscopy may show a blue mass behind the tympanic membrane
	Glomus tympanicum	Otoscopy shows reddish pulsatile mass behind the tympanic membrane	Excision