Pulsatile Tinnitus Clinic

Pulsatile tinnitus (PT) is a symptom that affects nearly five million Americans. The sensation of hearing a rhythmic noise, such as a heartbeat, swooshing or whooshing, from no external source, is, at best, a little unsettling; for many, the near constant sound exceeds annoyance and becomes completely debilitating. Nearly 60% of patients who experience this issue also suffer from some form of depression or anxiety. These rates are significantly higher than those associated with other chronic conditions due in large part to the difficulty of diagnosing the root cause of symptoms. 

Pulsatile Tinnitus

Origins and Associations

Pulsatile tinnitus can have many different origins, some fairly benign, others potentially life-threatening. Sources can include vascular malformations, abnormal cerebral pressures, and unique blood flow patterns near the ear. The condition can also be caused by the presence of a tumor. Even when the causes of PT are fairly benign, its effects are sufficiently incapacitating for most patients to seek help.  

Why UCSF

Identifying the source of pulsatile tinnitus and moving to resolve it safely and finally is vital to all patients, whether their condition has a potentially fatal cause or not. That resolution escapes many patients for lengthy periods, however, as they move from one physician to another, steadily frustrated by incomplete answers. The UCSF Pulsatile Tinnitus Clinic, led by Matthew Amans, MD, takes a multidisciplinary approach involving specialists from the departments of Radiology, Neurology, and Psychiatry who collaborate to diagnose and treat today's patients, and further study PT to help future patients. 

Highlights

The group has a diagnosis success rate of over 90%. Read one patient's story here.

Referring Your Patients to the UCSF Pulsatile Tinnitus Clinic

Consultations should include:

  1. Patient demographics;
  2. Patient insurance;
  3. Referral (brief description of medical condition and reason for consultation).

Billing & Insurance

After a procedure is scheduled, UCSF’s Central Authorization Unit will help patients and referring practices with pre-service insurance authorization or pre-service coverage determination when the patient is referred by a UCSF provider. Patients referred by non-UCSF providers must obtain insurance authorization through their referring physician’s office. In most cases this procedure is covered by insurance plans, including Medicare. UCSF’s Radiology Billing Department is happy to answer any questions about billing or provide price estimates for any Radiology services, call (415) 514-8888.

Pulsatile Tinnitus Clinic News

Pulsatile Tinnitus: One Patient’s Quest to End Ominous Ringing in Her Ear

It started in her right ear, a persistent whooshing sound that interfered with sleep and increasingly distracted her from daily activities.  Learn more


Society of Neurointerventional Surgery in Boston

July 25-28, 2016

Presentations of four abstracts on pulsatile tinnitus.

Prominent Condylar Veins Causing Pulsatile Tinnitus: Dynamic Angiographic Confirmation

pulsatile tinnitus abstract1

Turbulent Flow in the Venous Outflow Tract of Pulsatile Tinnitus Patients with Sigmoid Sinus Diverticulum

pulsatile tinnitus abstract2

Venous Blood Flow Visualization in Sigmoid Sinus Diverticulum Using MRI

pulsatile tinnitus abstract3

Jugular Vein Flow Patterns in Patients with Pulsatile Tinnitus Using Computational Fluid Dynamics

pulsatile tinnitus abstract4

Quantitative Imaging In Medicine and Surgery

September 3, 2015

Abstract

It has not been previously possible to investigate the link between the presentation of flow related symptoms, such as pulsatile tinnitus, and flow patterns (1). In recent years, magnetic resonance imaging (MRI) has able to determine the full velocity field in 3-dimensional (3D) space through the cardiac cycle. We used MR flow imaging in vivo and in vitro with a patient-specific flow model to study the flow patterns in the dominant right sigmoid sinus and jugular vein of a patient who presented with right-sided subjective pulsatile tinnitus which cannot be heard by an examiner auscultating the head.

Pulsatile Tinnitus flow patterns MRI

ASHNR 2015

April 13, 2015

This research was to develop a guideline to assist physicians to obtain the most helpful imaging workup for pulsatile tinnitus evaluation.

Imaging Evaluation of Pulsatile Tinnitus

Pulsatile Tinnitus Research

Acevedo-Bolton G, Amans MR, Kefayati S, Halbach V, Saloner D. Quant Imaging Med Surg 2015;5(4):635-637. doi: 10.3978/j.issn.2223-4292.2015.04.09 was featured on the cover of the journal. 

Abstract

It has not been previously possible to investigate the link between the presentation of flow related symptoms, such as pulsatile tinnitus, and flow patterns (1). In recent years, magnetic resonance imaging (MRI) has able to determine the full velocity field in 3-dimensional (3D) space through the cardiac cycle. We used MR flow imaging in vivo and in vitro with a patient-specific flow model to study the flow patterns in the dominant right sigmoid sinus and jugular vein of a patient who presented with right-sided subjective pulsatile tinnitus which cannot be heard by an examiner auscultating the head.

Publications

  1. Hasan DM*, Amans M*, Tihan T, Hess C, Guo Y, Cha S, Su H, Martin AJ, Lawton MT, Neuwelt EA, Saloner DA, Young WL. Ferumoxytol-enhanced MRI to Image Inflammation within Human Brain Arteriovenous Malformations: A Pilot Investigation. Transl Stroke Res. 2012 Jul; 3(Suppl 1):166-73. PMID: 23002401. * Shared first authorship

  2. Amans MR. Acute Methotrexate Toxicity: Case of the Week. American Journal of Neuroradiology. Published online 12/10/2012.

  3. Amans MR, Phillips CD. Hepatoblastoma metastatic to brain mimicking intracranial hemorrhage case report and review of the literature. Radiology Case Reports. 7(2) 2012.

  4. Amans MR, Stout C, Fox C, Narvid J, Hetts SW, Cooke DL, Higashida RT, Dowd CF, McSwain H, Halbach VV. Cerebral arteriopathy associated with Arg179His ACTA2 mutation. BMJ Case Rep. 2013; 2013. PMID: 24293535. (BMJ publisher chose to publish article in both J Neurointerv Surg and BMJ Case Rep)

  5. Von Fischer ND*, Amans MR. Dissecting aneurysm of the left PICA: Case of the Week. American Journal of Neuroradiology. Published online 2/2013.

  6. Kansagra AP, Cooke DL, English JD, Sincic RM, Amans MR, Dowd CF, Halbach VV, Higashida RT, Hetts SW. Current trends in endovascular management of traumatic cerebrovascular injury. J Neurointerv Surg. 2014 Jan 1; 6(1):47-50. PMID: 23322749

  7. Amans MR, Stout C, Dowd CF, Higashida RT, Hetts SW, Cooke CL, Narvid J, Halbach VV. . Resolution of pulsatile tinnitus after coil embolization of sigmoid sinus diverticulum. Austin J Cerebrovasc Dis & Stroke. 2014; 2(1):1010.

  8. Chow ML, Cooke DL, Fullerton HJ, Amans MR, Narvid J, Dowd CF, Higashida RT, Halbach VV, Hetts SW. Radiological and clinical features of vein of Galen malformations. J Neurointerv Surg. 2014 Apr 30. PMID: 24789593.

  9. Alexander M, Cooke D, Meyers P, Amans M, Narvid J, Dowd C, Halbach V, Higashida R, Hetts S. O-012 demographic and lesion characteristics outperform degree of stenosis in predicting outcomes following stenting for symptomatic intracranial atherosclerosis. J Neurointerv Surg. 2014 Jul; 6 Suppl 1:A7. PMID: 25064986.

  10. Amans MR, Stout C, Fox C, Narvid J, Hetts SW, Cooke DL, Higashida RT, Dowd CF, McSwain H, Halbach VV. Cerebral arteriopathy associated with Arg179His ACTA2 mutation. J Neurointerv Surg. 2014 Nov; 6(9):e46. PMID: 24353327.

  11. Amans MR, Cooke DL, Vella M, Dowd CF, Halbach VV, Higashida RT, Hetts SW. Contrast Staining on CT after DSA in Ischemic Stroke Patients Progresses to Infarction and Rarely Hemorrhages. Interv Neuroradiol. 2014 Feb; 20(1):106-15. PMID: 24556308. PMCID: PMC3971133

  12. Hetts SW, Cooke DL, Nelson J, Gupta N, Fullerton H, Amans MR, Narvid JA, Moftakhar P, McSwain H, Dowd CF, Higashida RT, Halbach VV, Lawton MT, Kim H. Influence of patient age on angioarchitecture of brain arteriovenous malformations. AJNR Am J Neuroradiol. 2014 Jul; 35(7):1376-80. PMID: 24627452

  13. Hetts SW, Tsai T, Cooke D, Amans M, Narvid J, Dowd C, Higashida R, Halbach V. E-021 de novo, progressive, multiple, and recurrent intracranial dural arteriovenous fistulas: characteristics and outcomes. J Neurointerv Surg. 2014 Jul; 6 Suppl 1:A47. PMID: 25064936.

  14. Amans MR, Narvid J, Halbach VV. Intra-arterial chemotherapy for bilateral retinoblastoma via left ophthalmic artery and right anterior deep temporal artery. BMJ Case Rep. 2014; 2014. PMID: 25240013. PMCID: PMC4170497

  15. Amans MR, Aysenne A, Halbach VV. ICA "T" lesion: Clinical correlation. American Journal of Neuroradiology. Published online 7/2014.

  16. Moftakhar P, Cooke DL, Fullerton HJ, Ko NU, Amans MR, Narvid JA, Dowd CF, Higashida RT, Halbach VV, Hetts SW. Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings. J Neurosurg Pediatr. 2015 Mar; 15(3):282-90. PMID: 25555113.

  17. Hetts SW, Tsai T, Cooke DL, Amans MR, Settecase F, Moftakhar P, Dowd CF, Higashida RT, Lawton MT, Halbach VV. Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes. AJNR Am J Neuroradiol. 2015 Jul 23. PMID: 26206813.

  18. Alexander MD, Rebhun JM, Hetts SW, Kim AS, Nelson J, Kim H, Amans MR, Settecase F, Dowd CF, Halbach VV, Higashida RT, Cooke DL. Lesion location, stability, and pretreatment management: factors affecting outcomes of endovascular treatment for vertebrobasilar atherosclerosis. J Neurointerv Surg. 2015 Mar. PubMed PMID: 25795438. ENG.

  19. Chow ML, Cooke DL, Fullerton HJ, Amans MR, Narvid J, Dowd CF, Higashida RT, Halbach VV, Hetts SW. Vein of Galen Malformations: long-term functional outcome of 6 cases. J Pediatric Neuroradiology (in press).

  20. Narvid J, Amans MR, Cooke DL, Hetts SW, Dillon WP, Higashida RT, Dowd CF, Halbach VV. Spontaneous Retroclival Hematoma: A Case Series. J Neurosurgery (in press).

  21. Acevedo-Bolton G, Amans MR, Kefayati S, Halbach V, Saloner D. Four dimensional magnetic resonance velocimetry for complex flow in the jugular vein. Quant Imaging Med Surg. 2015 Aug; 5(4):635-7. PMID: 26435930. PMCID: PMC4559987.

  22. Amans MR, Meisel K, Glastonbury C. Dural arteriovenous fistula: Clinical correlation. American Journal of Neuroradiology. Published online 12/2015.

  23. Alexander MD, Cooke DL, Meyers PM, Amans MR, Dowd CF, Halbach VV, Higashida RT, Hetts SW. Lesion stability characteristics outperform degree of stenosis in predicting outcomes following stenting for symptomatic intracranial atherosclerosis. J Neurointerv Surg. 2016 Jan; 8(1):19-23. PMID: 25416828.

Multidisciplinary Team

Matthew Amans, MD, Co-Director, Pulsatile Tinnitus ClinicMatthew Amans, MD
Co-Director, Pulsatile Tinnitus Clinic
Assistant Professor of Radiology
Neurointerventional Radiology
 

 

Karl Meisel, MD Co-Director, Pulsatile Tinnitus ClinicKarl Meisel, MD
Co-Director, Pulsatile Tinnitus Clinic
Assistant Professor
Neurology
 

 

Alvin Lau, MDAlvin Lau, MD
Assistant Professor
Psychiatry

 

 

Christine Glastonbury, MDChristine Glastonbury, MD
Professor
Mentorship Director, ENT Radiology

 

 

Van Halbach, MDVan Halbach, MD
Professor

 

 

 

Wade Smith, MD

Wade Smith, MD
Professor
Neurology

 

 

David Saloner, PhD

Professor
MSBI Program Director


 

 

Charles Limb, MDCharles Limb, MD
Professor, OHNS