Abstract
Two cases of carotid steno-occlusive disease with pulsatile tinnitus are reported.
Case 1. A 57-year-old hypertensive woman complained of pulsatile tinnitus on the right side. Bilateral cervical and right orbital bruits were heard with the stethoscope. Compression of the right carotid artery decreased both the tinnitus and the bruits. Angiography revealed stenoses of the right internal carotid artery at its bifurcation and the siphon. Stenosis of the eustachian tube was found, the inflation of which resulted in attenuation of her tinnitus.
Case 2. A man of 54 years complained of pulsatile tinnitus on the left side five months before he had left hemiparesis and anosognosia. Angiography showed occlusion of both the right internal carotid artery and the right middle cerebral artery. Collateral circulation from the left internal carotid artery was found. A CT scan revealed a right parietal infarction. Two months later, the patient began to walk and his tinnitus reappeared. Through auscultation of the neck we found a systolic carotid bruit on the left side. Both the bruit and the tinnitus disappeared after compression of the left carotid artery.
An absolute stenosis of the carotid artery, possibly of atheromatous origin, might have resulted in the pulsatile vascular tinnitus in case 1.
A relative stenosis, contralateral occlusion of the carotid artery, might have caused tinnitus in case 2.
Pathophysiological mechanisms of pulsatile vascular tinnitus were discussed.
