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 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pulse-synchronous tinnitus suggests a vascular etiology and is deemed rare by the otologic literature. During the period 1978-1985 we evaluated 20 patients with the sole or initial complaint of pulsatile tinnitus. Fourteen patients had objective pulsatile tinnitus, perceived by the patient and the examiner alike, and 6 had subjective pulsatile tinnitus, perceived by the patient only. Angiographic findings in patients with objective pulsatile tinnitus included dural or pial arteriovenous malformations, occlusive disease of the intra- or extracranial carotid arteries from atherosclerosis or dissection, panarterial ectasia, and venous sinus thrombosis. Most of the patients with subjective pulsatile tinnitus had normal evaluations, but other possible causes of subjective pulsatile tinnitus included a carotid occlusion and pseudotumor cerebri. Pulsatile tinnitus is an uncommon symptom produced by a variety of causes. Given the abnormalities present in our series, we would recommend intraarterial digital subtraction angiography or conventional angiography in the evaluation of objective pulsatile tinnitus and intravenous digital subtraction angiography for subjective pulsatile tinnitus. Increased intracranial pressure must also be considered.
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PMID:Pulsatile tinnitus. 381 Jul 61

Cardiopulmonary bypass surgery is commonplace in many medical centers and rare instances of unilateral hearing loss in these patients have been reported and have been attributed to embolism. Two more patients are reported and their discovery prompted a study of pre and postoperative hearing in 68 patients at Newark Beth Israel Medical Center, where a single team performs the cardiopulmonary bypass surgery. Previous similar studies showed no changes following CPB surgery. Almost all patients have been male and prolonged pump times (over 150 min.) were noted in 7 of 11 reports. Based on changes in hearing found on pre and postoperative testing in the 6 patients, 3 groups were developed: those with no change and those with slight changes were compared with those having average deficits of more than 10 db. Prolonged pump times occurred only twice in the series and were not associated with loss. A second milder form of hearing loss, which was bilateral and affected the high tones, was noted in significant numbers. Two of these patients had persistent tinnitus after surgery. Although the series is small, there appears to be an increased susceptibility in males to the development of high tone loss as well. Based on the preponderance of males, with their high incidence of basilar artery atherosclerosis, and the frequent prolonged pump times, perfusion failure seems to be the most likely etiology for the rare cases of hearing loss accompanying cardiopulmonary bypass surgery.
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PMID:A study of the effects of cardiopulmonary bypass surgery on auditory function. 732 24

Pulsatile tinnitus can often be a diagnostic problem. This communication reports the authors' experience on 100 patients with pulsatile tinnitus and describes a practical and effective diagnostic approach. Better understanding of the various etiologies of pulsatile tinnitus, coupled with the introduction of magnetic resonance angiography, in conjunction with magnetic resonance imaging, have made a major impact on the evaluation of this symptom in recent years. Cerebral angiography, previously performed on the majority of patients, is presently indicated in selected cases only. Intracranial hypertension, glomus tumors, and carotid atherosclerosis were the most common diagnoses made in our patients.
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PMID:Pulsatile tinnitus: recent advances in diagnosis. 819 43

Doppler ultrasound examination is an easy and non-invasive examination technique to image the anatomical and functional situation of cervical vessels. An increasing number of ENT-specialists has been using Doppler sonography in the diagnosis of cochlear and vestibular disorders. We analysed the frequency of pathological Doppler examination results of 150 patients with vertigo, hearing loss and tinnitus. Especially patients with vertigo bear a greater risk for stenosis of the extracranial arteries (28%) compared to an asymptomatical population (1%). Patients with hearing loss and tinnitus showed a different degree of artery disorders (23% of the patients with hearing loss; 18% of the patients with tinnitus). Patients bearing no risk for atherosclerosis showed in 13% (vertigo) and 8% (hearing loss and tinnitus) stenosis of the cervical arteries. Thus we found by Doppler ultrasound examination more stenoses in patients with cochlear or vestibular symptoms than in an asymptomatical population. The early attribution of stenosis to a malfunction of the inner ear helps to avoid invasive examinations of cervical vessels. In addition to this, imminent cerebral ischaemia can be revealed at an early stage.
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PMID:[Incidence of Doppler ultrasound detectable stenoses of cervical arteries in patients with cochlear-vestibular symptoms]. 826 28

Objective tinnitus represents sound wave energy that, by definition, may be heard or recorded by an examiner. It may occur as a result of either muscular contraction or turbulent blood flow. We report two cases of vascular objective tinnitus resulting from internal carotid artery stenosis. The first patient, a 74-year-old man, underwent ligation of the right internal carotid artery because of the distal extent of atherosclerosis. The second patient, a 75-year-old man, underwent a right carotid endarterectomy. Both patients noted complete relief of their tinnitus. The spectrum of vascular causes and treatment options are reviewed.
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PMID:Objective tinnitus resulting from internal carotid artery stenosis. 908 Nov 43

To examine the influence of hyperlipidemia and smoking on age-related changes in caloric response and pure-tone hearing, a caloric test and pure-tone audiometry were performed in 14 healthy volunteers and in 78 tinnitus patients without subjective hearing loss. The patients were from 24 to 84 years of age, and were divided into 4 groups: the no-risk group (N group), the smoking alone group (S group), the hyperlipidemia alone group (L group), and the smoking plus hyperlipidemia group (S-L group). Slow phase eye velocity of the caloric nystagmus (SPEV) and average hearing level at high frequencies were compared between the N groups and the other groups. There was a significant difference in SPEV only between the N and S-L groups, but not in the hearing level. This suggests that age-related changes in the caloric response be promoted by atherosclerosis, unlike presbycusis.
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PMID:Influence of hyperlipidemia and smoking on age-related changes in caloric response and pure-tone hearing. 965 10

Nine patients (group A) were found on magnetic resonance angiography (MRA) to have excessive carotid artery, vertebral artery, and vertebrobasilar junction tortuosity. A control group (group B) were age- and sex-matched to group A patients, were selected randomly from our MRA or stroke data banks, and had not undergone MRA for evaluation of migraine, "carotidynia," or pulsatile tinnitus. Factors more prevalent in group A patients included migraine, chronic daily headache, carotidynia, pulsatile tinnitus, and a positive family history of headache. Factors more prevalent in group B patients included a positive family history of stroke, large-vessel atherosclerosis, and scan evidence of ischemic infarctions; many group B patients had undergone MRA for stroke or transient ischemic attack evaluation. Men were slightly underrepresented at 44%, and were younger than women (34 +/- 6 years vs. 43 +/- 3 years; p = 0.01). Relationships in this preliminary study between arterial tortuosity and migraine seem evident.
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PMID:Tortuosity of carotid and vertebral arteries: a magnetic resonance angiographic study. 978 Aug 56

Tinnitus is a frequent symptom but a tinnitus that is rhythmic and synchronous with the patient's heartbeat is rare. The symptom "pulsating noise in the ear" may be due to various cause but most frequently, by glomus tumors, intracranial hypertension and atherosclerosis of the carotid arteries. Pulsatile tinnitus can often present a serious diagnostic problem. The diagnostic evaluation includes physical examination, audiologic assessment and imaging techniques (ultrasonic examination of cervical vessels, high-resolution computed tomography of the temporal bones, nuclear magnetic resonance, angiography of the carotid arteries and magnetic resonance angiography). Evaluation should be individualized but must include a thorough ENT work up. The evaluation of the patient includes otomicroscopy, palpation and auscultation of ears and cervical region and the head positioning test. The cause of pulsatile tinnitus may be even identified on otoscopic examination. Further investigations by other specialities (neurology, internal medicine, ophthalmology) may become necessary. Life-threatening causes such as arteriovenous shunts or carotid artery stenosis must be ruled out. Nevertheless, in several cases it will not be possible to determine the etiology of tinnitus. Finally, therapeutic options which occasionally can include surgical techniques or interventional radiology are discussed.
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PMID:[Pulsating tinnitus]. 1070 57

Tinnitus, a buzzing or ringing in the ear, may be pulsatile or continuous (nonpulsatile). The distinction, with a detailed clinical evaluation, determines the most appropriate imaging study. Pulsatile tinnitus suggests a vascular neoplasm, vascular anomaly, or vascular malformation. Most of the neoplasms are glomus tympanicum and glomus jugulare tumors. Vascular anomalies may cause pulsatile tinnitus, but the mechanism is unknown, and another (treatable) cause should be sought. Most neoplasms and anomalies are best seen on bone algorithm computed tomographic (CT) studies. Dural vascular malformations are often elusive on all cross-sectional imaging studies; conventional angiography may be necessary to make this diagnosis. Flow-sensitive magnetic resonance (MR) images show vascular loops compressing the eighth cranial nerve. Carotid dissections, aneurysms, atherosclerosis, and fibromuscular dysplasia can be identified on both MR imaging or MR angiographic studies and CT or CT angiographic studies. Otosclerosis and Paget disease are CT diagnoses. Benign intracranial hypertension often has no abnormal imaging findings. For patients with nonpulsatile tinnitus, MR imaging is the study of choice to exclude a vestibular schwannoma or other neoplasm of the cerebellopontine angle cistern. Multiple sclerosis and a Chiari I malformation are rare causes of pulsatile tinnitus, also best seen on MR studies. Many patients with tinnitus have no abnormal imaging findings.
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PMID:Imaging of tinnitus: a review. 1092 51

The analysis of the epidemiological data indicates that exposure to noise is widespread and it is one of the most common causes of tinnitus, estimated at about 20.7% according to Hazell; 28% according to Axelsson; and 42% according to Palmer. Bearing in mind the scantiness of reliable data on the incidence and nature of tinnitus in persons exposed to industrial noise, and especially the need for the objectivity of this subjective symptom, the authors have decided to undertake the study aimed at assessing the interrelation between tinnitus, the magnitude and kind of hearing impairment, and otoacoustic emission. The study group included 191 persons aged 42.5 +/- 7.6 years (range, 25 to 65), occupationally exposed to noise at the levels of 88-92 dB(A) for 26.9 +/- 4.6 years (range, 9 to 30) who had reported hearing disorders and tinnitus. The control group, matched by similar age and duration of employment, consisted of 80 persons with perceptive hearing impairment induced by industrial noise who had not complained of tinnitus. The results of the study revealed that in 59.7% of the study subjects, noise proved to be one of the most probable factors responsible for the development of tinnitus. The presence of tinnitus was found in 22.5% and in 46% of the study subjects after 10 years and 11-20 years of noise exposure, respectively. In 95.8% of workers, tinnitus was associated with hearing loss, and only in 4.2% of cases it occurred in ears with normal hearing. In persons exposed to noise, tinnitus was most frequently (59.2%) bilateral and permanent. Following the audiologic examinations, verified by objective audiometry (tympanometry, ABR), cochlear hearing impairment was found in 68.6%; retrochochlear in 8.37%; mixed and other forms of impairment, e.g. presbyacousis, in 19.4% of subjects. The audiologic assessment of tinnitus demonstrated that in 62.3% of persons, tinnitus occurred at high frequencies and correlated with the magnitude of hearing impairment in the tonal audiogram. The tinnitus intensity ranged between 10-15 dB and 45 dB. In 40.3% of those under study, noise was not the only tinnitus-risk factor. In this group of persons, the presence of predisposing diseases was also observed, e.g. hypertension, diabetes, atherosclerosis, disturbed lipid metabolism and other etiologic factors that might have impact on the tinnitus incidence, ototoxic drugs, for example. The measurements of evoked otoacoustic emission (EOAE and DPOAE) revealed in 58.63% of persons significant differences (p < 0.01) in the amplitude and spectrum of EOAE in the ears with tinnitus as compared to the ears without tinnitus with a similar hearing threshold. Whereas in 27.74% of subjects, no differences in the EOAE measurements in the ears with or without tinnitus were observed. The results of DPOAE measurements showed in 62% of subjects significant differences in DP-grams in the ears with tinnitus as compared to the ears without tinnitus (p < 0.01). Interestingly, the differences in measurements of both types of evoked emissions (EOAE and DPOAE), expressed by the lowered amplitude, narrowed spectrum, reduction of emission or its complete fading in a limited area of high frequencies, were demonstrated in the ears with tinnitus only in retrocochlear hearing impairment, as compared to those free from tinnitus. The evaluation of the EOAE and DPOAE measurements seems to prove that this method may be useful in assessing the contribution of the cochlear mechanisms to the incidence of tinnitus and in distinguishing between tinnitus generated in cochlea and tinnitus with the source at other levels of the hearing organ or beyond it. Our study failed to determine the interrelation between tinnitus and spontaneous emissions as the emission was registered only in about 12% of persons exposed to noise, including 2% of those with normal hearing.
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PMID:[Tinnitus in noise-induced hearing impairment]. 1182 43


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