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


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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1. Lockwood AH, Salvi RJ, Burkard RF, et al. Tinnitus. N Engl J Med 2002;347:904–910.
2. De Ridder D, Menovsky T, Van de Heyning P. An otoneurosurgical approach to non-pulsatile and pulsatile tinnitus. B-ENT 2007;3(suppl 7): 79–86.
3. Mattox DE, Hudgins P. Algorithm for evaluation of pulsatile tinnitus. Acta Otolaryngol 2008;128:427–431.
4. Sismanis A, Girevendoulis A. Pulsatile tinnitus associated with internal carotid artery morphological abnormalities. Otol Neurotol 2008;29:1032–1036.
5. Sismanis A. Pulsatile tinnitus: a 15-year experience. Am J Otol 1998;19:472–477.
6. Xenellis J, Nikolopoulos TP, Felekis D, et al. Pulsatile tinnitus: a review of the literature and an unusual case of iatrogenic pneumocephalus causing pulsatile tinnitus. Otol Neurotol 2005;26:1149–1151.
7. Anderson JE, Teitel D, Wu YW. Venous hum causing tinnitus: case report and review of the literature. Clin Pediatr (Phila) 2009;48:87–88.
8. Liess BD, Lollar KW, Christiansen SG, et al. Pulsatile tinnitus: a harbinger of a greater ill? Head Neck 2009;31:269–273.
9. Lehmann MF, Mounayer C, Benndorf G, et al. Pulsatile tinnitus: a symptom of chronic subclavian artery occlusion. AJNR Am J Neuroradiol 2005;26:1960–1963.
10. Rathinam S, Pettigrew AM, Pollock JC. Intractable tinnitus and sensorineural deafness cured by surgical correction of coarctation of aorta. Interact Cardiovasc Thorac Surg 2004;3:431–433.
11. Chadha NK, Weiner GM. Vascular loops causing otological symptoms: a systematic review and meta-analysis. Clin Otolaryngol 2008;33:5–11.
12. Gultekin S, Celik H, Akpek S, et al. Vascular loops at the cerebellopontine angle: is there a correlation with tinnitus? AJNR Am J Neuroradiol 2008;29:1746–1749.