Dural Arteriovenous Fistula Presenting as Pulsatile Tinnitus

—A Self-Report—

Abstract

I present my own case here: I, a 49-year-old man, a doctor who has been practicing as an otorhinolaryngologist for 25 years and was previously healthy, developed pulsatile tinnitus. I developed sudden-onset pulsatile tinnitus, with a pulsating feeling and very slight swelling in my neck, without pain. For early diagnosis, palpation and auscultation of the neck are considered useful in the general outpatient clinic, and color Doppler ultrasound imaging has also been reported as being potentially beneficial in ENT practice. In my case, cerebral angiography for definitive diagnosis showed a dural arteriovenous fistula in the left sigmoid sinus fed by dural branches of the occipital artery. I underwent endovascular treatment for the involved left sigmoid sinus at admission. The pulsatile tinnitus disappeared immediately after the treatment and has not recurred for four years after the treatment. My case emphasizes the importance of early diagnosis of dural arteriovenous fistula in the ENT clinic to obtain good outcomes. I recommend palpation, auscultation of the neck, and color Doppler ultrasound imaging for all patients with pulsatile tinnitus, followed by MRI, MRA, and preoperative angiography at an advanced medical institution for the diagnosis of critical conditions such as a dural arteriovenous fistula. My experience serves as evidence to support the use of endovascular treatment as a safe and effective treatment for dural arteriovenous fistula. Dural arteriovenous fistula is a potentially curable entity that we should bear in mind in the differential diagnosis of patients presenting with pulsatile tinnitus.