CTA and MRA/V Produce Same Results? Are These Findings Enough to Hear Pulsatile Tinnitus?

I'm on the NHS and have had a CTA.

The report came back negative, my right side arteries is dominant in terms of size, I have tinnitus in my right ear.

Here are some summaries

"The bony wall of the petrous carotid canal, separating it from the middle ear cleft is thin but intact."

Would that be enough to hear pulsatile tinnitus?

It sounded like the consultant wanted to dismiss me if the CTA came back negative. I see him again tomorrow.

I've read around and seen that a cerebral anagram, MRA/V and ultrasound are all needed in order to rule out all possible causes. Is this true.

I hear a booming sound when tapping my neck below my ear, more loudly if I tap the carotid artery.

I also hear a wooom sound when I turn my neck. The pulsatile tinnitus is triggered with a increase in blood pressure and or heartbeat quickens. When my ET or middle ear is full of fluid I get pulsatile tinnitus but also when sleeping on my right side, I could hear the mucus squishing along with my heartbeat. Leading me to believe the carotid is too close to my middle ear or ET.

So should I try to request more tests? Will an MRA be more clear or helpful in diagnosis?

 

"The bony wall of the petrous carotid canal, separating it from the middle ear cleft is thin but intact."

No, doesn't sound like a problem but you'd want a neurotologist to make that determination over a neuro-radiologist or neurologist. Point in fact, a neurotologist is who you always want to see first when it comes to tinnitus or pulsatile tinnitus.

They're different tests for different things too. A CTA is best to reveal any problems in the neck - carotids, et al. A MRV is best to look at the brain to see if their are any fistulas or stenoses evident. The problem with PT in general is it's like looking for a particular needle in a stack of needles. Besides the usual venous culprits it can be cause anything impeding bloodflow - generally an osteophyte (bone spur) anywhere along your spine - though generally the C-spine in particular. The auditory nerves in the brain are very sensitive and quite conductive to it could sound like it's in the ear but in fact be occurring somewhere else entirely. It's a real sonofabitch.

Things to rule out/get tested for as well
Semi Superior Canal Dehisance
Microvascular Compression Syndrome

A neurotologist will test you for those anyway. Which is why I recommend skipping the ENT and just going straight to the real professional.

If utilizing your neck is modifying the sounds you should at least get a general Xray and evaluation of it., Also go for massage and or physio session and get an assessment of the general state of your fascia and muscle groups for the T & C spines - traps and rhomboids in particular. See if there are guarding issues with those muscles. That can come from a compromised C-spine - advanced disc degeneration, loss of lordosis, osteophytes impinging on things they're shouldn't be, etc. Depending on the Xray findings a trip to a neurosurgeon for an assessment may be in the cards as well.

In short, if the PT isn't strictly neurological - and that generally only happens under more extreme conditions like stroke, TIA, intercranial hypertension, etc. than it's more likely related to a somatic problem from the T-spine up. It could be related to the heart but that's a long shot. Have you done doppler to check for atherosclerosis, in the carotids at any rate? As long it's below 50% that's fine. Anything over could be the problem as well.

So lots of option, lots of possibilities. Meantime if it's causing you a lot of anxiety consider going on nortriptyline for a while to help level out. It won't stop the problem but it helps you deal with the anxiety stemming from it.

Meanwhile start learning what you can about the various conditions associated with it. The more you know, the less likely any needed tests will be missed - because you'll be able to point them out. And even if they can't tell you what it is, telling you what it isn't helps too. The rest is all common sense stuff, try physio, neck and core strengthening exercises, clean up your diet and manage stress. That may end up resolving the problem on its own too.

Good luck