Do you have pulsatile tinnitus where a whooshing sound in one or both of your ears coincides with your heartbeat? Do you think or have been told that it is being caused by an aneurysm? Let’s explore the connection between pulsatile Tinnitus and aneurysms.
Firstly, Are You Sure it is an Aneurysm that is Causing Your Pulsatile Tinnitus?
An aneurysm can definitely cause a case of pulsatile Tinnitus. But, the incidence is rare. In fact, less than 1% of all pulsatile Tinnitus cases are diagnosed as stemming from an aneurysm, according to findings of this study. The same study also listed the following common causes of pulsatile Tinnitus.
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Common Causes of Pulsatile Tinnitus
Unknown – 40%
The causes of a majority of pulsatile Tinnitus cases are still unknown or undiagnosed. Pulsatile Tinnitus often requires very complex imaging studies to establish a proper diagnosis. In many cases, causative anomalies are simply not found or are missed.
Internal Carotid Artery (ICA) Stenosis – 18%
Your ICA or internal carotid artery is the set of large arteries that run alongside the side of your neck. They carry blood from your heart to your face, head and brain. Stenosis occurs when these arteries narrow due to plaque buildup, a condition known as atherosclerosis.
Intracranial Hypertension – 16%
This condition is caused by a build-up of pressure around the brain. It can be caused by forceful trauma, stroke, blood clots, tumors or even by brain infection.
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High Jugular Bulb – 12%
A jugular bulb is a venous (network of veins) structure that is found close to the inner ear. It is estimated that 2.4% to 7% of all temporal bones have a high riding jugular bulb, a vascular anomaly where the bulb applies pressure on the middle or inner ear. The jugular bulb is not present at birth and develops as a person ages. It is not known why the jugular bulb becomes a high or high riding jugular bulb in some people.
Dural Arteriovenous Fistula – 7%
This Fistula is an abnormal connection between arteries and brains. It can be formed in the dura matter that covers the brain or spinal cord.
Vascular Tumors – 6%
A vascular tumor is one that is caused by excessive growth of blood vessels in the brain or spinal cord. They are usually benign in nature. They are also usually flow-rich tumors.
Aneurysms – 1%
As mentioned earlier, pulsatile Tinnitus caused by aneurysms are very rare. You will find more details on aneurysms and pulsatile Tinnitus below. Because pulsatile Tinnitus causing aneurysms are so rare, it would be prudent to seek a second opinion or differential diagnosis for your Pulsatile Tinnitus. There is a chance that one of the more common causes could have been missed.
How do Aneurysms cause Pulsatile Tinnitus?
The resulting turbulence is sometimes heard by the inner ear which then presents the symptom as Pulsatile Tinnitus
As shown and explained in the adjoining picture, an aneurysm causes the hemodynamics of blood passing through an aneurysm’s sac to change after passing through it. Blood essentially becomes turbulent after passing through this bulge.
When the aneurysm is located close to the ear’s structures, like for example in the Petrous part (the bones on the side of your skull) of your ICA (Internal Carotid Artery), the turbulence can be picked up by the inner ear which you then hear as a whooshing pulsatile sound, every time your heart beats.
How Are Pulsatile Tinnitus Causing Aneurysms Diagnosed?
Aneurysms are hard to detect. They will usually require a barrage of imaging studies that include CT, MRI, MRA (Magnetic Resonance Angiography), ultrasound, intra-arterial cerebral angiography and very advanced imaging studies like Digital Subtraction Angiogram (DSA). In many cases, several of these images have to be correlated to come up with a strong diagnosis.
Diagnosing a pulsatile tinnitus causing aneurysm is particularly difficult due to the complex anatomy found under the side of the skull, where the ear structures are located.
How are Pulsatile Tinnitus Causing Aneurysms Treated?
A procedure called an endovascular coil embolization is the safest and least invasive way to treat an aneurysm that might be causing pulsatile Tinnitus.
This procedure doesn’t require an incision. Instead, a micro-catheter is used to reach the aneurysm, using a special form of x-ray called fluoroscopy that helps guide the catheter. Once the aneurysm is reached, the surgeon will use an electrical charge to make the micro catheter release very tiny spring like platinum coil or coils, depending on the size of sac. The aim will be to release these coils in a position where they cause the aneurysm to clot (embolize), thereby cutting off blood supply. So, this procedure preserves the parent artery and does not need clipping or ligation. If successful, the patient can resume normal activities in as little as 2 days after surgery.
Endovascular coil embolization procedures are generally safe. However, they may not always be feasible to perform. If this procedure isn’t feasible, other techniques may be used. They include; endovascular balloon occlusion, revascularization with bypass or surgery. Sometimes, patients may be recommended very conservative management that includes blood thinners and diet modification to keep blood pressure in check.
And, of all the treatment procedures, open surgery is the most difficult and risky option, often also requiring the patient to undergo a long recovery period, even after successful surgery.
