Is Magnetic Resonance Angiogram Helpful in the Treatment of Pulsatile Tinnitus?

January 27th, 2011 |

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Although CT is the primary choice in the imaging modality for pathologies of the temporal bone, magnetic resonance angiogram or MRI has a noteworthy contribution to the diagnosis in the following ways:

It shows the pathology of the membranous labyrinth.
Assessment before a cochlear implantation.
It shows complex inflammatory and infectious diseases
It shows the extension and the location of temporal bone tumors.

Moreover, MRI is also the first choice in dealing with retro cochlear tumors or infections that cause neuro-otologic symptoms. It is also necessary in detecting all the kinds of lesions in the brain stem and brain that are related to the hearing pathways. In the recent years, MRI has been used extensively in detecting the causes of pulsatile tinnitus. Cerebral angiography is only preferred in selected cases. In case of objective pulsatile tinnitus, which can be heard on physical examination, MRI and conventional angiography is used widely for detecting the cause of the disease.

Dolichoectasia, which is a fusiform dilatation of an artery, can cause pulsatile tinnitus. MRI and MR angiography are mostly preferred for imaging investigations in the patients of dolichoectasia.

MRI is also often suggested in the younger patients who suffer from unilateral pulsatile tinnitus.

In order to understand the management and clinical spectrum of pulsatile tinnitus better a study was conducted in which the files of around 84 patients were analyzed. Non-invasive techniques such as MRI, CT and angiography were used to investigate the individual patients in a tailored way. The results showed that the patients of pulsatile tinnitus should be compulsorily investigated with non-invasive techniques. If these are negative then selective angiography is required for diagnosis and to guide treatment. MRI and MRA are more much more sensitive than CT.

By and large, the most significant part of evaluation for tinnitus is a detailed history and physical exam conducted by an otologist or ENT. A hearing test is also essential. Special tests such as MRI, blood tests, CT and auditory brainstem response are also needed sometimes.

Since, pulsatile tinnitus implies a vascular abnormality, the preferred imaging study is magnetic resonance imaging or MRI and contrast-enhanced computed tomography or CT of the brain.

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