The Mechanism of Pulsatile Tinnitus and Treatment

Pulsatile tinnitus (PT), a common otology symptom, is synchronous with patient’s heartbeat. PT is generally objective, induced by cranial vascular sound, and its mechanism is a biomechanical problem. Multiple etiologies and treatments were proposed in clinical studies, but without quantitative analysis in view of biomechanics. In this chapter, both numerical and experimental models were developed for quantification of generation, propagation and reception of PT sound in view of biomechanics. Based on these models, two commonly reported etiologies were analyzed, including sigmoid sinus cortical plate dehiscence/thinness and hyperpneumatization of temporal bone air cells. It is indicated in results that dehiscence of sigmoid sinus cortical plate would directly induce PT, while thinness would not. Normal pneumatization temporal bone cavity would amplify PT sound mostly, but the pneumatization grade would not be the direct etiology of PT. Based on the findings, we propose that PT patients with sigmoid sinus cortical plate dehiscence undergo plate resurfacing surgery, while the patients with thinness should not receive resurfacing surgery. For patients with only hyperpneumatization shown in radiology data, other etiologies should be searched and considered.