Diagnosis

How is PT diagnosed?

Diagnosis begins with a clinical assessment, including a detailed history and examination to suggest whether the tinnitus is venous or arterial in origin. Listening over the skull and neck with a stethoscope may reveal a sound that is audible to the examiner, termed objective pulsatile tinnitus. Hearing tests and tympanometry can also be useful.

Imaging is chosen according to the suspected cause. Ultrasound of the carotid arteries and neck veins can identify flow disturbances or narrowing. CT of the head and neck provides detailed anatomy, with high-resolution temporal bone CT particularly useful for sigmoid sinus or jugular bulb abnormalities. MRI gives information about the brain, inner ear and surrounding soft tissues. Specialised MRI techniques, such as MRA and MRV, are used to study arteries and veins, including screening for transverse sinus stenosis and dural arteriovenous fistulae.