The International Tinnitus Journal

A Rare Case of Unilateral Pulsatil Tinnitus

Author(s): Liliana Filipa Invêncio Da Costa, Fabian Alzate Amaya, María Menéndez Riera, Mercedes Álvarez-Buylla Blanco, Anselmo Padin Seara

Introduction: Tinnitus is a common reason of consult and constitutes a very incapacitating symptom. Objective tinnitus accounts for only 5% and has various etiologies. Dural Arteriovenous Fistulas (dAVFs) are an example, but they are an unusual cause.
Case report: We present one case of a male patient with 48 years followed in the Otorhinolaryngology (ORL) consult for a left pulsatile tinnitus with 3 months of evolution. The physical examination was normal; the initial basic complementary exams were normal (audiometry, impedanciometry, analytical and cerebral Computed Tomography (CT)). Given the clinical persistence, it was decided to request a brain Magnetic Resonance Imaging (MRI) that led to the suspicion of a dural arteriovenous fistula in the transverse sinus. The study was completed with an arteriography identifying a low grade dAVF at the level of the left sigmoid sinus.
Discussion: The dAVFs, although infrequent, constitutes a treatable cause of tinnitus, so the awareness must be present in the diagnostic approach of all patients with pulsatile tinnitus, especially if it is unilateral. We also carried out a review of the medical/surgical management of this pathology.

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