Dental Cone Beam CT — 3D — Any Help for Pulsatile Tinnitus (PT) Diagnosis?

[Kate]

Hi, I've had pulsatile tinnitus for about 10 years now (and no more habituated today than when it started) and have had a full vascular workup, many doctors look at my scans, and no vascular cause can be found. I've almost given up on that type of testing.

The pulsatile tinnitus comes from a place in front of my ear right above the TMJ, and increases in volume when I press where the joint is. I saw my dentist recently and she said I had no TMJ dysfunction (and no symptoms) but she mentioned these cone beam CT scans, and when I looked them up, I wondered if it might help figure out why I hear this infernal noise in my ear all the time (although finding a dentist who knows anything about pulsatile tinnitus would be quite a feat).

I found a thread about this test under the tinnitus forum category. I'm wondering if anyone has had any help from this type of test for diagnosing the cause of pulsatile tinnitus? Kate

 

[Greg Sacramento]

@Kate I had posted in one of the 3D cone beam CT scan threads. I had at least six of these tests.
Your PT may have association to your soft palate - the roof of your mouth - as you press the joint, but not related to TMJ and most often it isn't. More likely related to tooth trauma and/or saliva glands when the oral cavity is suspect.

 

[Kate]

Thanks for replying Greg. Do you think one of these tests would help, even though I don't expect the dentist to be familiar with PT? Wondering why you had 6! What do you mean by the PT may have an association with the soft palate? I did have a tooth pulled from that upper side less than a year before the PT started, not the molar or wisdom tooth as they were already both gone. If you have any thoughts/ ideas on how to pursue this I would be very grateful.

 

[Greg Sacramento]

@Kate Since you had so many exams and testing where possible associations to PT have been ruled out and feel
the PT comes from a place in front of your ear right above the TMJ, and increases in volume when you press where the joint is.

Muscle Spasms
Muscle spasms within the ear can associate with pulsatile tinnitus or a regular clicking sound in the ear. There is a small muscle, in the soft palate, which is attached to the stapes bone. If this muscle spasms, there are chances of a rumbling sound being produced in the ear. Having ruled out blood flow associations, this can relate to a tooth trauma removal having pocket infection. So when pressure is applied to the joint, nerves of the soft palate spasms. A cone beam study would be helpful to examine area of tooth removal.

Do you have thick extra salvia?
Any swallowing difficulties?
GERD - acid reflex?
Sinus problem?
Any tooth implants?
Any soreness of lips or face?

 

[Kate]

Greg, I've read about the bones in the ear that can vibrate, and occasionally get rumbling sounds in my ears too, but the PT is distinct, always there, high-pitched ssssshhhhh sound (same tone almost as the steady hissing in the other ear) in time with the pulse. The only thing that reduces the volume temporarily is pushing down on the top or back of the head, or jaw movements in or out. My guess is these movements move the offending vein away from the hearing apparatus enough to lessen the sound temporarily.
2 things are making me curious about these 3D xrays - I had a wisdom tooth removed many years ago, it crumbled during extraction and the guy said he left fragments in there, "that wouldn't cause me any problems for a long time". Also I had another tooth pulled from that side, less than a year before the PT started, so there are no teeth on the back left (PT) side.
I have a suspicion a 3D xray might reveal something, I just doubt dentists are familiar with PT and so would they know the significance? Did you have these tests for the PT or T? Were you working with a dentist who was familiar with it?
As for the other questions:
kinda thick saliva, no GERD, allergies,no other sinus problems, no implants, or soreness.
Katrina

 

[Greg Sacramento]

@Kate Very informative and suspected response to my thoughts.
PT in both ears could indicate the soft palate (roof of mouth) as cause (being of central position) from reaction of pocket fragments on just one side of jaw. Tooth trauma and/or removal, salvia glands, veins and nerves are other keywords.
Thick salvia (salvia glands) has many causes, but it could go hand in hand to possible cause(s) above and you may not have an WBC infection.
A 3D cone x ray scan with an oral dentist would be helpful.
A CT on jaw, non cone has radiation risks.
A MRI has benefits, but the noise factor needs to be considered.
If you decide on a 3D cone x ray which is not much more than 30 seconds - wear some foam plugs. The machine isn't loud, but it passes by the ears.
Headphones can't be worn because the arm of the machine moving around your head would hit the headphones.

 

[Melike]

I have somehow a similar symptom. I have 4-5 morse code type intermittent tones which STOPS when I press near my TMJ or incrase / add new tones when I move my ear canal, when I release it, they immediately stop. We might have similar causes. It is so frustrating that it looks 'treatable' but they can't just find the cause.

 

[Kate]

yes Melike, it is very frustrating. Moving my ears don't make any difference to my sounds and I have multiple regular T sounds. The PT is constant and only changes in volume depending on where I press. If I press down on my head the PT will almost stop for a minute or so. It's pretty much the only "relief" I can get from it.