Severe Pulsatile and Regular Tinnitus with Hearing Loss — Should I Get a CT Angiography (CTA)?

Hi all!

So glad there is community around tinnitus, and this forum!

I am posting in the hopes that others who have walked some of this journey might be willing to give me some advice.

I have had severe pulsatile tinnitus in both ears, "regular" tinnitus, and hearing loss for 6 years. The pulsatile tinnitus is so bad I can still hear it when walking past someone running a leaf blower! It's 24/7 and never leaves me. I have to take sleeping pills every night just to get some rest, since it's like trying to sleep next to a car alarm.

I have listened to the samples on Whooshers.com, and my pulsatile tinnitus doesn't sound like that - instead, my "regular" tinnitus sounds like I am standing under a loud static powerline, with a pulsing on top of that in rhythm with my heartbeat. I cope by breaking down every few months with this, but the break downs are getting less frequent. It's still really difficult to deal with. So here's my question...

I have had a CT of the head, ultrasound of my carotid arteries, MRI, and MRA/MRV. All come back normal and I feel like I'm a real nut case. I have asked both a neurosurgeon and an ENT doctor whether I should get a CTA (CT Angiography), but am concerned about the radiation given I have already had one, and at even less than 3 CTs your risk for cancer is increased (small increase, but it's there)... and from what I have seen, a CTA has one of highest doses of radiation you can get during an imaging test (Source: Radiation risk from medical imaging - Harvard Health).

A friend of mine who is a neuropharmacologist told me that because the sound is in both ears there is likely nothing they can do. The neurosurgeon said that the chance of finding something in the CTA was small since my MRA results were normal, but I could get one if I wanted to. The ENT said similar, saying "The radiation is worth it if they find something, but definitely not if they don't." Gee. Thanks. Sigh...

So I am trying to decide whether to get a CTA as a next step. Is there anyone on here who had the cause of their pulsatile tinnitus identified after a CTA, even though their MRA/MRV was normal?

Any advice?

Thank you so much for reading to the end and any suggestions you might be willing to share.

Kindly,
Sarah

 

@PTsufferer, did you have a CBC & Chem test - blood work?

Was your radiologist a Neuro Interventional Radiologist? If not, I would consider having one note your CT of the head, MRI, and MRA/MRV - a second opinion for exams taken. Consider consulting with a Neuro Interventional Radiologist. Angiography or other testing may later be considered.

 

Hi Greg,

Thank you so much for your reply! I have had a CBC that had values within the normal range but not sure what you mean by Chem Test?

My CT, MRI, and MRA/MRV were conducted by radiology technicians, and I have had the images read by a neurosurgeon as well for a second opinion. (The same neurosurgeon that said I could have a CTA, but the odds of it showing something would be low.) The only thing the MRA showed is that my jugular vein was "slightly larger than what would be considered normal."

When you recommend seeing a interventional neuroradiologist, were you recommending that they order new MR tests? I am considering sending my images for a second opinion by a neuroradiologist (here's the resource in case it helps someone else: Our Radiologists | DocPanel | DocPanel.com) but it is pricey and I am not certain if you're saying brand new tests would be needed anyway?

Thanks again!!!

Sarah

 

I have similar tinnitus and have been asking around. Electrical pulsatile tinnitus, however mine is reactive. MRI found nothing.

 

@PTsufferer, increased pressure from a slightly larger or smaller jugular vein can affect your ears, causing dizziness, tinnitus, pulsatile tinnitus and/or hearing loss. I have seen this on occasion.

The right interior jugular vein is always slightly larger than the left.

Did notations mention interior or exterior jugular veins?

Stenosis - The narrowing of a jugular vein or other blood vessel. It can happen because of injuries, scarring, or various diseases. Much more likely from an injury. Surgery can help - should become pulsatile tinnitus free.

Thrombosis - This is when a blood clot forms inside a vein or gets stuck there. Clots caused from infection after surgery or from infections in throat or neck. If there's a clot inside a smaller jugular vein, which is very possible, then blood thinners should make you pulsatile tinnitus free. Antibiotics may help.

Hearing loss would not be a factor, unless you also have hearing loss induced tinnitus.

Interventional Neuroradiologist is better trained for neck and head with tinnitus, but your Neurosurgeon may be satisfactory.

It may be that CTA would now help.

 

Ugh - I have never heard of the electrical pulsatile tinnitus being reactive. Must admit I kind of wish my was reactive instead of being 24/7, but still electrical pulsatile tinnitus is like the worst regardless! Sorry you have to deal with that. Have you tried a MRV/MRA? It's the same noise level as MRI but can see if you have something vascular going on.

I looked in my radiological reports and do not see any comments about internal vs. external jugular veins. Unfortunately an injury caused the pulsatile tinnitus, "regular" tinnitus, and the hearing loss. Thank you for pointing out stenosis and thrombosis - I have considered venous sinus stenosis before and your feedback has given me a few areas to explore (bearing in mind not to be paranoid along the way in the interest of diagnosing and resolving this issue). It's such a challenge, and I appreciate the time.



I will also look at other posts to see if I can be of any help to others. Many (not all) doctors are so dismissive of tinnitus and the pulsatile variety it boggles my mind.

 

I had no idea about the CTA. Guess I'm fucked since I've had 6 in my lifetime, head and neck, with them finding nothing. 4 of those in less than 3 years. How do these doctors get away with this shit.

I have pulsatile tinnitus in both ears too. A neurointerventional radiologist read my CTA and saw venous sinus stenosis on my right side that nobody else picked up, but he said it doesn't explain why I hear it on both sides.

I had hearing loss and hyperacusis from a concert and got the pulsatile tinnitus with it. Not sure if it's noise-induced or what.

 

I think normal tinnitus can mess up your perception of sound in the way that it is more difficult to estimate the direction/the source. I also experienced this. And if the sound is loud, it might be therefore difficult to tell if one hears it in both ears/head.

This might be one possible explanation.

 

Hi dolpinskin,

I am just extra cautious and may inform myself a little too much before receiving medical care!

I think it's promising that a neurointerventional radiologist read your CTA to find venous sinus stenosis on your right side. Did they talk about placing a stent? I am of course not a doctor, so this isn't medical advice, but thought I'd drop a link about the condition and potential treatment for you to consider:

Pulsatile Tinnitus Venous Sinus Stenosis and Stenting

 

@PTsufferer -

I can strongly relate to your situation, especially when you went to the whooshers.com site and your pulsastile tinnitus sounded nothing like their examples. I’ve never heard the term electrical pulsatile tinnitus is before, but it is a good definition of what it feels like.

I have been to all the specialists including ENT, neurologist, neurosurgeon, dentist, and have had the same battery of tests that you have had and the results were normal. This is what most of us are told, and yet it is still there and there is no treatment which is one reason why it is so difficult. One of the tests wasn’t even covered by insurance! But I still would have had this MRI just to rule anything out.

Regarding your concern about the CTA, I share your concern about radiation especially if you’ve already had one. Upon thinking about it, though, just for peace of mind I think I would probably go ahead and do it. It was also brought up by the neurosurgeon team but they felt it wouldn’t show anything new.

Like I say, if it were suggested, I would probably go for it.

I also have a sleep medicine regimen. Falling asleep without a medication would not be happening.

Like you say, it’s always there, and is not reactive. One night several years ago I noticed hearing sounds while trying to fall asleep, the next day it started. I don’t think anything specific brought it on. Nothing seems to make it better or worse, thus not considering it reactive.

Good luck with your decision.

Laura

 

@LauraK4 -

My "electrical" and pulsatile tinnitus started actually in the middle of the night, and woke me up from sleep. I've heard it 24/7 ever since. It seems to be louder and softer at different times, but it seems to be completely random (no identifiable cause), which freaks me out even more.

Mine is best described as a static sound, that has a rhythmic pulsing/cycling to it. It's absolutely maddening - I am sorry to hear you too cannot sleep without meds. Mind if I ask if yours has a pulsing sound too, or is it a constant "electrical"/static sound?

It's so crazy-making when you hear the sound and they cannot find a cause - I know it's frustrating to put yourself through a battery of tests and be no further along in knowing what's going on.

Best,
Sarah

 

Neck vascular injury (Stenosis - Thrombosis) is a common cause of pulsatile tinnitus. Several non-neck or brain/head conditions can also be cause. If cause wasn't found above the shoulders, then other examinations is needed.

@PTsufferer, can you give an area of injury? An injury can also cause UPSTROKE. UPSTROKE is increased blood flow pressure from an upper area, mid section injury area or lower body injury area. If it's mid section, also a quick, sudden - often very brief blood pressure increase can cause a hypertension event.

When one has regular tinnitus and then later develops pulsatile tinnitus, there are only a few common possibilities.

One is inline with injury and/or emotional excitement causing blood pressure hypertension. Blood pressure hypertension can travel to the carotid arteries and then the ears will notice sounds. Carotid artery exams would be normal. These sounds would be exactly what you describe - standing under a loud static powerline, with a pulsing on top of that in rhythm with heartbeat. I have the same sounds caused from an abdominal aortic injury that caused hypertension blood pressure.

Anemia could also have input if emotional stress developed after injury, but I doubt it.

A second question: Were your shoulders twisted when the injury happened?

Third question: Age - young, middle age or older?

Exams:

Electrocardiogram, complete body stethoscope study, blood pressure studies and complete blood work.

If this post has some rhythm and reason to your situation, then Hydralazine or Sulodexide may help.

 

@Greg Sacramento, thank you for the follow-up questions!

To question 1: Unfortunately I had a brain injury after which I had post-concussive syndrome

Hence my imaging has mostly focused on the brain but I did have an ultrasound of the carotid arteries in my neck. The only thing I know of that I haven’t gotten is CTA and lumbar puncture but there may be other tests I should try to pursue.

I typically have normal blood pressure although at times it does run a little low (runs in my family).

To question 2: To my knowledge, my shoulders were not twisted during my injury.

To question 3: I am a middle aged woman - mid 40’s.

I am sorry to hear of your abdominal aortic injury - I imagine that can be pretty serious? Hopefully surgery was able to resolve your issue!