Aim: In 15% of patients with pulsatile tinnitus, no cause can be found. It has been proposed
that compression of the auditory and vestibular nerve trunks by vascular loops might
be the etiology of otherwise unexplained hearing loss, tinnitus, and vertigo. Our
objective is to present the case of a woman with unilateral pulsatile tinnitus attributed
to a vascular loop.
Material: A 47-year-old woman was seen in April 2006 with right pulsatile tinnitus, which had
begun suddenly 4 months before. There were no associated symptoms such as hearing
loss, vestibular symptoms, or facial nerve paralysis. There was also no history of
ototoxic drug use, ear disease, head injury, or exposure to excessive noise.
Method: Otological and physical examinations were normal. She was normotensive. The full
blood count excluded anemia. A blood test revealed hyperlipidemia. Pure tone audiometry
and tympanometry were normal. Auditory brainstem evoked potentials (ABR) and electronystagmography
(ENG) revealed no pathology. The carotid and vertebral triplex was normal. The patient
was further evaluated with MRI brain scan with gadolinium and MR angiography which
revealed a vascular loop in close association with her right eighth nerve.
Results and Conclusions: A vascular loop should be regarded as a cause of pulsatile tinnitus when any other
possible etiology is excluded. Audiograms, ABR, ENG, and radiographic imaging all
play a role in the diagnosis.
