Missed Artery to Vein Diagnosis — Arteriovenous Malformation

This story of my Pulsatile Tinnitus might help you and your reply or posts might help me. I developed Pulsatile Tinnitus starting in about May of this year. It started with a just small whooshing sound and now is a large whooshing sound followed by a sort of wheeze. In July I finally visited a local ENT in Simi Valley, CA. He looked at my throat, neck glands, and ears and found nothing unusual. He ordered a audio test which showed no hearing loss. He then ordered an MRI & MRA of my head with contrast. The Radiologist reported negative findings. The ENT then referred me to Dr Brackmann of the famous House Ear Clinic in Los Angeles.

The earliest appointment I could get was over 2 months away on Oct 3rd. Meanwhile I started to develop a strange coordination problem with my tongue so the ENT referred me to a local Neurologist. The Neurologist could find no stroke issue but put a stethoscope to the back of my ear and neck and reported hearing the pulsatile sound too. He then ordered MRA and CT contrast scans of my neck. The radiologist reports were again negative. Within about a week my tongue problem had disappeared. So I waited for the House appointment in Oct.

At the House appointment, Dr. Brackman looked at the images from all the MRI, MRAs, & CT that I brought to him on a CD. He also listened extensively to the back of the ear area using a stethoscope and inside the ear using a single tube like instrument. He wanted his top radiologist to look at the scan images the next week and report back to me as he had an idea what was going on. The next week I went back in and he showed me a bright spot on the CT in an area in back of my left ear inside the skull. He said a artery was sending blood to a vein without first going through a capillary. This was making the sounds. I was surprised that the local radiologist missed the spot on the CT scan because it looked so obvious when pointed out to me.

He advised me that I could leave it alone if I could live with the noise that will likely get worse; however, it could be treated by an Angiogram where they would run a probe up inside an artery from my leg area to behind my ear and contrast the area to verify the problem with a real time x-ray. Then if it is what they think, they could block the artery area to the vein and hopefully stop the noise.

That same day I even walked over to St. Vincents Hospital across the street and spoke with the top Radiologist who does the angiograms. He too informed me there is always a slight risk of a stroke with this procedure.

So now I am just taking time to research this more and to see what perhaps others have done and what others might learn from my experience. Look to see replies and other related stories.

 

Hello Paul,

You seem to have a chance of full recovery, which is excellent news. I understand it a risky procedure though so you need to make this difficult decision yourself. Is your pulsatile tinnitus is very severe?

 

Intraparotid Superficial Temporal ArteryArteriovenous Malformation Causing Persistent Pulsatile Tinnitus

Selleck, Anne Morgan; O’Connell, Brendan; Patel, Samip; Clark, Joseph Madison

Abstract
Objectives:
This article discusses the diagnosis, imaging workup, and management of a rare cause of pulsatile tinnitus: intraparotid arteriovenous malformation.

Patient:
A single patient with a superficial temporal arteriovenous malformationdiagnosed by carotid duplex causing pulsatile tinnitus that failed initial surgical management. Repeat imaging failed to identify a cause for the persistent tinnitus.

Intervention:
Reoperation with a parotid approach based on physical exam findings.

Results:
Removal of a more proximal arteriovenous malformation in the parotid gland resulted in long-term resolution of the patient's pulsatile tinnitus.

Conclusions:
Physical examination is essential in the workup and management of pulsatile tinnitus. Imaging is a useful adjunct in the diagnosis of pulsatiletinnitus but should not be solely relied upon.

Source: https://journals.lww.com/otology-ne...arotid_Superficial_Temporal_Artery.96137.aspx