Conflicting Diagnoses for Pulsatile Tinnitus: Nerve Compression vs Arachnoid Granulation

SueX

Member
Author
Feb 25, 2025
17
Tinnitus Since
2024
Cause of Tinnitus
Possibly Eustachian Tube Dysfunction
I'm struggling with two very different diagnoses for my pulsatile tinnitus. I had extensive imaging done in November and December, which was interpreted by a consultant radiologist. His view was that my vestibular and cochlear nerves are in contact with my anterior inferior cerebellar arteries. The worst side is the one where I experience the pulsatile tinnitus.

Then, a couple of days ago, a consultant neurosurgeon reviewed my images and said there is a very large arachnoid granulation. It is a herniation of the arachnoid dura into the right transverse sinus. He believes that would be the cause of the tinnitus, not the nerve compression. However, the herniation is on the right side, while the tinnitus is on the left.

I am not sure what to do about these two different diagnoses, each leading to a different treatment path. Any advice?
 
Cortical mastoidectomy with resurfacing of the sigmoid sinus was suggested to me by a skull base surgeon to help alleviate my pulsatile tinnitus, which has a vascular cause. Has anyone here had this procedure? I believe it is relatively new, but it seems to be fairly well tolerated and reasonably effective at reducing pulsatile tinnitus, although there is not much information available about it.
 

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