OBJECTIVE TINNITUS

• Main Authors: PATRICIA VIVEROS DÍEZ, JAIME SANTOS PÉREZ, VIVIANA ANDREA CIFUENTES NAVAS, JESÚS EDUARDO RAMÍREZ SALAS, MARTA ALONSO MESONERO, DARIO MORAIS PÉREZ
• Format: Article
• Language: Spanish
• Published: Ediciones Universidad de Salamanca 2019-06-01
• Series: Revista ORL
• Subjects: acúfenos objetivos; pulsátil
• Online Access: https://revistas.usal.es/index.php/2444-7986/article/view/20657

<p>Introduction: The tinnitus is a sound perception that is classified as objective or subjective, as evidenced or not by organic cause. Objective tinnitus is usually perceived by the examiner and represent 5% of all tinnitus.</p><p>It is estimated that 10-17% of the world population suffer tinnitus. The causes that originate objective tinnitus are multiple, arterial or venous alterations, tumor etiology and others such as intracranial hypertension, perilymphatic fistulas or Paget's disease. For its diagnosis it is useful to perform audiometric tests and otoscopy. However, for the differential diagnosis of its etiology, an MRI, an angio MRI or in some cases, a CT scan of the ear’s petrous bone is required.</p><p>The first choice treatment must be etiological, affecting the underlying disease; it is based on a pharmacological, psycho-emotional or mostly surgical treatment.</p><p> Material and methods: We present three cases of objective tinnitus diagnosed in our service of diverse etiology. The three cases we present, are women aged between 44 and 53 years at the time of diagnosis who came to our service for the perception of a pulsatile tinnitus, two of them in the left ear and one of the patients in the right ear. The audiometry and impedanciometry are normal. That is why brain MRI and MR angiography are requested.</p><p> Results: One of them presents changes that may be related to benign intracranial hypertension, currently under follow-up by neurosurgery.</p><p>In another case, there was a saccular aneurysm in the supraclinoid segment of the left internal carotid artery, and another aneurysm in the paraophthalmic segment of the right internal carotid artery that was confirmed with a cerebral angiography, which is also under follow-up by neurosurgery, with control of tensions and hygienic-dietetic measures.</p><p>In the latter case, a dural arterio-venous fistula was found at the ipsilateral sigmoid-lateral sinus confluence, which is embolized with subsequent neurological control. </p><p>Conclusions: Tinnitus is a frequent cause of consultation in otorhinolaryngology, which in some cases can be disabling. The three cases that we present have three different etiologies but all of them have been diagnosed by MR angiography.</p><p>We must pay special attention to any patient who comes with pulsatile tinnitus targets, since the diagnosis is otolaryngologist’s responsibility, although it must be subsequently derived for proper treatment.</p>