Case Report

Resolution of Pulsatile Tinnitus Following an Upper Mediastinal Lymph Node Resection

Authors: Yi-Zarn Wang, DDS, MD, J Phillip Boudreaux, MD, Richard J. Campeau, MD, Eugene A. Woltering, MD

Abstract

External compression of extracranial/mediastinal vessels has not been reported as an etiology of pulsatile tinnitus. We present a case in which compression of extracranial vasculature led to long term pulsatile tinnitus which resolved completely with surgical resection of metastatic lymph nodes. This should be included in the list of differential diagnoses when dealing with any patient with a complaint of pulsatile tinnitus. Patients with advanced carcinoid cancer often present with distant metastases to their left superior mediastinum and supraclavicular lymph node chain. We believe a careful search for nodal metastases compressing vascular structures in such patients is warranted as debilitating pulsatile tinnitus may be cured by a simple surgical procedure.


Key Points


* Pulsatile tinnitus may be chronic and debilitating.


* The etiology of pulsatile tinnitus is usually vascular in origin.


* Pulsatile tinnitus may be very difficult to diagnose despite an extensive workup.


* A search for extracranial nodal vascular compression should be carried out in all patients who experience unexplained pulsatile tinnitus.

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