El paciente nos cuenta que tiene un zumbido pulsátil: Acúfeno pulsátil

Acúfeno pulsátil

Abstract

Introduction and objective: Ringing of the ear is a frequent complaint of patients who come to an ENT consult. Of these, 90-95% are subjective, but in 5-10% of the cases the examiner can also listen to them. These are called objective tinnitus (somatosounds). In these objective pulsatile tinnitus, the patient describes a sound that is synchronic with the heart rhythm. It is very rare, and its pathophysiological mechanism is related to the turbulence of blood flow. We present a new case of a dural arteriovenous fistula, aiming to draw attention to the importance of identifying the somatosound, find its cause and be able to treat it, liberating the patient from his misfortune and avoiding, as in the case presented, the severe consequences that it can entail. Clinical Case: The narrative is the experience of a 66-year-old man, a physics teacher, who suffered for 5 months the intermittent sound of a dural fistula, which could have had been easily embolized. We found the description of his story so interesting that we asked him to transcribe it for us, allowing us to share it in his own handwriting. He also managed to isolate in an audible noise, a diffuse recording that he made himself with a mobile phone. By selective catheterization of both internal and external carotid arteries and the right vertebral artery, the existence of a transdiploic arteriovenous fistula at the torcula level is confirmed. It shows intracranial drainage and passage to the right transverse sinus, with contributions of cutaneous branches of both occipital arteries, as well as a meningeal branch of the right vertebral artery that is possible to embolize up to the fistula. Discussion: It is not difficult to overlook an objective tinnitus among many of a subjective nature. If the patient expresses that it has a synchrony with the arterial pulse, in addition to an ENT examination, we will perform a careful palpation and auscultation of the cranial vault and the cervical-mastoid region, looking for throbbing or an audible murmur. Once objectified, we will look for its cause. There are algorithms in the literature that help us get to the diagnosis. When the usual imaging studies do not identify it, selective arteriography can allow, as in the case presented, to find its origin and also to perform the treatment. Conclusion: When facing a pulsatile tinnitus, we must apply the algorithm that makes its diagnosis and treatment possible.