Pulsatile Tinnitus and Venous Sinus Anomalies

Pulsatile tinnitus is a form of tinnitus in which patients perceive a rhythmic sound that often synchronises with their heartbeat. Unlike subjective tinnitus, which arises from cochlear or neural dysfunction, pulsatile tinnitus commonly has a vascular origin. Among these, anomalies of the dural venous sinuses—including transverse sinus stenosis, sigmoid sinus diverticula or dehiscence, and abnormal jugular bulb anatomy—play a central role. Altered venous outflow can induce turbulent flow or pressure gradients against thinned bony walls, transmitting vascular vibrations to the inner ear and producing an audible pulsation. Idiopathic intracranial hypertension, temporal bone pneumatization and asymmetries in venous drainage further modulate the risk and severity of symptoms. Advances in non-invasive imaging, computational fluid dynamics and surgical techniques have clarified pathophysiological mechanisms and guided tailored interventions such as transmastoid sinus wall reconstruction, stenting or endovascular coiling. Contemporary research emphasises the need for patient-specific anatomical evaluation to identify the precise venous anomaly, predict the efficacy of different treatments and minimise recurrence.

Research from Nature Portfolio

Recent studies have explored how anatomical variations of the temporal bone and venous sinuses influence the presentation and management of pulsatile tinnitus. One investigation of nearly five hundred temporal bone computed tomography scans revealed that the extent of pneumatization strongly correlates with the position and morphology of the jugular bulb and internal carotid artery, whereas the sigmoid sinus shows less morphological change. This finding highlights how aerated temporal bone regions can alter the proximity of bony partitions to vascular structures, affecting the likelihood of symptomatic wall dehiscence. In parallel, a longitudinal analysis of surgical outcomes for patients with sigmoid sinus diverticula or dehiscence demonstrated that tailored transmastoid resurfacing or reshaping achieves sustained relief in both subjective and objective measures over more than a year of follow-up. Objective recordings showed persistently reduced pulse-synchronous sound amplitudes and improved low-frequency hearing thresholds, supporting the durability of firm materials in reconstructing venous sinus walls and preventing recurrence of turbulent flow.

Pulsatile Tinnitus and Venous Sinus Anomalies publication trend

The graph below shows the total number of articles in pulsatile tinnitus and venous sinus anomalies across all publications each year (not limited to Nature Index journals).

Technical terms

Pulsatile tinnitus: Perception of a rhythmic sound synchronised with the cardiac cycle, typically of vascular origin.

Venous sinus stenosis: Narrowing of dural venous channels that can elevate upstream pressure and induce turbulent flow.

Sigmoid sinus diverticulum/dehiscence: Outpouching or focal bone defect of the sigmoid sinus wall allowing vascular vibrations to be transmitted to the ear.

Pneumatization: Development of air-filled cavities in the temporal bone that affect the relationship between bone and adjacent vasculature.

Jugular bulb: The superior dilated portion of the internal jugular vein, whose height and dehiscence influence the risk of pulsatile tinnitus.

Computational fluid dynamics (CFD): Numerical simulation of fluid (blood) flow patterns used to predict pressure, velocity and vortex formation in vascular anomalies.

References

1. Influence of pneumatization on morphology of temporal bone-related vasculatures and their morphometric relationship with ear regions: a computed tomography study. Scientific Reports (2023).
2. Longitudinal analysis of surgical outcome in subjects with pulsatile tinnitus originating from the sigmoid sinus. Scientific Reports (2020).
3. High jugular bulb in patients with non‐thrombotic internal jugular venous and transverse sinus stenosis: Clues to pathogenesis. CNS Neuroscience & Therapeutics (2023).
4. Multiphysics Interaction Analysis of the Therapeutic Effects of the Sigmoid Sinus Wall Reconstruction in Patients with Venous Pulsatile Tinnitus. Bioengineering (2023).
5. MR Venous Flow in Sigmoid Sinus Diverticulum. American Journal of Neuroradiology (2018).