GGC - Primary Care
Background: Pulsatile tinnitus occurs when the patient becomes aware of their own pulse from their ear. If this occurs bilaterally, there is unlikely to be an ENT cause. Occasionally it can occur with “machine gun – like” noises with quick, repeated sounds – this is usually related to muscle spasms in the middle ear or Eustachian tube.
How to assess:
- Perform cardiovascular examination - bilateral pulsatile tinnitus would be considered cardiovascular and not due to an ENT disorder
- Examine the ear - Patients a conductive hearing loss may allow patient to become aware of pulsatile tinnitus. Vascular tumours / malformations of head and neck may have a tympanic membrane vascular lesion visible.
- Examine the neck - Vascular tumours / malformations of head and neck may have a neck mass
Referral guidance:
Bilateral pulsatile tinnitus would be considered cardiovascular and not due to an ENT disorder
Patients with an abnormality on ENT examination should be referred to ENT as appropriate
Patients with unilateral pulsatile tinnitus, no identifiable abnormality and normal cardiovascular examination should be referred to Audiology on a routine basis. Please ensure documentation of normal cardiovascular examination findings or the referral will be returned for this information.