Pulsatile Tinnitus

Hi Dr. Nagler,

Thanks for the time and support you give to TT.

I have a couple questions for you. About 3 months ago I developed Pulsatile Tinnitus, I hear a whoosh whoosh whoosh on my right ear.

At first it was thought to be an ear infection, but obviously it was not, no pain, other than a feeling of vibration as the turbulent blood flow moves through my head. Occasionally some headaches on that side only. Had several hearing tests, no hearing loss, all came back fine so it was determined by one ENT that the issue was not in my ears. But he had no idea what could be causing this, he dared to guess that maybe a vein close my ear. No answers as to why or how etc. Blood work came back fine too. I am 25 yrs, very healthy and active woman.

Since this started my GP keeps calling my issue 'tinnitus' and keeps telling me there is no cure for this, even though I tell her it is pulsatile and I can stop it when I press my neck. She even wants me to talk to a psychologist who deals with patients with tinnitus "since my issue might never go away and can't be cured, so more testing is a waste of money". She refuses to do more tests and keeps dismissing my PT as T.

I know more about PT than she does!

Have you encountered patients with vascular PT and how did you deal with them?

As a patient, how can I make sure GP's and other doctors don't dismiss my PT for T?

I just can't understand why is so hard for a patient with PT to be heard! I mean, both conditions are caused by completely different things and the treatment for both is also different...

I understand Pulsatile tinnitus is a bit rare to encounter so not many people know about it or why it happens... But I am getting frustrated. I am supposed to see another ENT but my GP called him and told him I have T. So now I am scared he will disregard me as well.

Kind regards,

Laura

 

@Laura89 posted [in part]:

Since this started my GP keeps calling my issue 'tinnitus' and keeps telling me there is no cure for this, even though I tell her it is pulsatile and I can stop it when I press my neck. She even wants me to talk to a psychologist who deals with patients with tinnitus "since my issue might never go away and can't be cured, so more testing is a waste of money". She refuses to do more tests and keeps dismissing my PT as T.

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OK. So your GP doesn't know a whole lot about pulsatile tinnitus. I get that. It happens. Nothing wrong with her not knowing much about a somewhat uncommon condition. But if she refuses to do some research on your behalf or at the bare minimum refer you to somebody who does know about pulsatile tinnitus, then for goodness' sakes FIRE her.

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I know more about PT than she does!

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Apparently so. Again, there's nothing wrong with her not knowing.

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Have you encountered patients with vascular PT and how did you deal with them?

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Loads of 'em.

What do I do? Well, I do my very best to find the cause. (That involves a thorough head and neck examination - including actually listening all over the head and neck with a stethoscope. And it often involves an MRA, a magnetic resonance angiogram.) Rarely, pulsatile tinnitus can be caused by an aneurysm, carotid plaque, or idiopathic intracranial hypertension. Those sorts of things, of course, require attention. Otherwise, what I would do in terms of addressing the pulsatile tinnitus is largely guided by how bothersome it is. If the pulsatile tinnitus is bothersome and its cause can be identified and safely corrected, then that's what I do. If the pulatile tinnitus is bothersome and if its cause cannot be corrected without undue risk or if its cause cannot be found, then if I usually recommend TRT, since the success rates for TRT are the same for pulsatile tinnitus as for non-pulsatile tinnitus.

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As a patient, how can I make sure GP's and other doctors don't dismiss my PT for T?

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If something causes you concern - pulsatile tinnitus, an ingrown toenail, or whatever - and you find your GP's response to be dismissive, then you need a new GP. (Unless, of course, your GP is having a "bad hair" day; we all get those!)

Dr. Stephen Nagler