Diagnosing Pulsatile Tinnitus without an MRI?

[weab00]

@Greg Sacramento

To sum up my myriad of issues, I whiplashed the right side of my neck in a martial arts class about two years ago. Following that, I used headphones at a very high volume for long periods of time. 6 months after the neck trauma, I developed tinnitus; I suspect it was from a combination of both whiplash and noise. There has also been some speculation of mewing. I proceeded to whiplash the left side of my neck as well from cracking it so hard to the point that I strained the muscles. After continuing to be reckless with noise, I developed hyperacusis in August of this year, although I highly suspect this is more so from continuing to use loud headphones after developing tinnitus than a somatic issue. Finally, following the hyperacusis, I also developed pulsatile tinnitus. My hunch is that the pulsatile tinnitus is being caused by the neck issues; I hear a thumping in both ears after exercising or wearing earmuffs. I also hear whooshing if I bend my neck beyond a 45-degree angle. If I point my hand over my neck then it stops the whooshing sound in one ear but the blood diverts to the other ear. I really can't afford to get an MRI for the sake of my hyperacusis, unfortunately even the quieter ones were too much for some of the people I talk with and it set them back. So MRI is pretty much off the table, but I could look into alternative scans. Is there any imaging process that isn't an MRI that can give me an accurate idea of what I'm dealing with?

Finally, I wanted to bring up that I developed TMJ after the immense stress that hyperacusis has brought upon my life. I get jaw clicking when I move it to the side or eat certain foods, unilateral headaches just above the TMJ joint, tenderness around my temples, and jaw fatigue after eating hard or chewy foods. What is the best course of action to take for this? I happen to have had braces for the past 1.5 years to correct my teeth, so a custom nightguard is not possible until I get them removed in a few months.

Would really appreciate your advice and thank you,
weab00

 

[Steph1710]

Hey!

I have pulsatile tinnitus as well as normal tinnitus.

Like yours, mine worsens with exercise and if I turn my neck. This usually means you have a blood flow/circulation issue at play.

If you press your neck, does the sound stop/lessen?

@tiniturtle is the person to ask for advice on here.

I actually have a diagnosis for my pulsatile tinnitus. I have a narrowed sinus vein in the left side of my head, and also the sigmoid sinus bone is missing. Luckily both can be operated on and eliminate the sound.

Hopefully @tiniturtle will see your post soon and respond!

Steph

 

[tiniturtle]

The whiplash could have caused a tear in a blood vessel in your neck or head. I would not wait to get this checked out. Especially if you have pulsatile tinnitus. I have regular tinnitus and I have no problems with MRI. There is a lot of fear mongering on this forum. They are loud, yes, but they give you earplugs, and you can even put headphones over them. I take naps during my MR studies. They aren't distressing to me.

You can do a Head CT or Head CTA. But then you're exposing yourself to cumulative radiation exposure. I'd rather deal with some noise than the prospect of cancer down the road. Sometimes these can be more useful in specific scenarios.

If you need a full evaluation, you should be given a cerebral angiogram, which isn't as bad as it sounds, after you look it up. I've done about 6 of these so far. The important thing is not to trust just any doctor, you really have to go to a good one.

Tinnitus and Pulsatile Tinnitus are not related in any way, an do not overlap them.

Please read this more thorough thread I wrote:

If You Have Pulsatile Tinnitus, Here's the First Thing You Need to Do to Get Answers and a Diagnosis

And this site, written by the medical group that treated me:

Diagnosis and Treatment of Pulsatile Tinnitus

 

[Lilah]

I was moderately anemic at one point (the symptoms appeared suddenly). The pulsatile whooshing sound reduced significantly once I started taking iron pills. However, I still have pulsatile tinnitus that is usually quiet but sometimes louder, and I can stop it by pressing on the neck area under my ear.

 

[Greg Sacramento]

@weab00 I had worked in the areas of whiplash, PT and hypertension for 28 years. Unfortunately, ironically I received all that you mention at 65 - whiplash from a dental experience, neck and jaw - somatic tinnitus, then PT from a combination of neck injury and hypertension.

This happened after a few years after receiving tinnitus from emergency ear syringing as I received a deadly bacterial infection from pigeon dust on the landing of an normally unused roof hospital helicopter patient access to the ER. I also received hyperacusis from this, but I managed to solve that.

Important is to avoid loud noise with whiplash. Consider a CTA or CTV. Need to know if your c spine and C1 was damaged affecting your stylist involving your carotids and then your jaw. Doubtful that other arteries and veins are involved, including vertebral arteries, but radiological exams are needed to know. I have posts that discuss this and we should have a private conversation where several back and forth messages will be needed. Also need to know if your C spine has any position changes. Only certain neck therapies are advised with what you have going on. Pressure therapy to neck is not advised as for c spine, neck arteries/veins/nerves and jaw. Outward extension therapy - pushing back very gently under ears. Will need to go into detail with this.

@weab00

There's a special CT method where the patient gets on knees and turns head in both directions. This is for those with both whiplash and pulsatile tinnitus.

 

[weab00]

The whiplash could have caused a tear in a blood vessel in your neck or head. I would not wait to get this checked out. Especially if you have pulsatile tinnitus. I have regular tinnitus and I have no problems with MRI. There is a lot of fear mongering on this forum. They are loud, yes, but they give you earplugs, and you can even put headphones over them. I take naps during my MR studies. They aren't distressing to me.

You can do a Head CT or Head CTA. But then you're exposing yourself to cumulative radiation exposure. I'd rather deal with some noise than the prospect of cancer down the road. Sometimes these can be more useful in specific scenarios.

If you need a full evaluation, you should be given a cerebral angiogram, which isn't as bad as it sounds, after you look it up. I've done about 6 of these so far. The important thing is not to trust just any doctor, you really have to go to a good one.

Tinnitus and Pulsatile Tinnitus are not related in any way, an do not overlap them.

Please read this more thorough thread I wrote:

If You Have Pulsatile Tinnitus, Here's the First Thing You Need to Do to Get Answers and a Diagnosis

And this site, written by the medical group that treated me:

Diagnosis and Treatment of Pulsatile Tinnitus

The thing is that I personally know people with hyperacusis who got far far worse after getting an MRI. They go up to 100 dB and a sound as low as 70 dB is enough to have catastrophic consequences with the current state of my ears. So unfortunately yeah, it's really off the table (I have all 3: hyperacusis, tinnitus, and pulsatile tinnitus).

Important is to avoid loud noise with whiplash. Consider a CTA or CTV. Need to know if your c spine and C1 was damaged affecting your stylist involving your carotids and then your jaw. Doubtful that other arteries and veins are involved, including vertebral arteries, but radiological exams are needed to know. I have posts that discuss this and we should have a private conversation where several back and forth messages will be needed. Also need to know if your C spine has any position changes. Only certain neck therapies are advised with what you have going on. Pressure therapy to neck is not advised as for c spine, neck arteries/veins/nerves and jaw. Outward extension therapy - pushing back very gently under ears. Will need to go into detail with this.

Thanks Greg,
What is the special CT method called? Should I see an interventional neuroradiologist?

 

[Greg Sacramento]

@weab00

I would not have any chiropractic manipulation or perform self neck therapy until seeing an interventional radiologist. There's a number of reasons such as carotid dissection. When the time comes for scheduled radiology exams, call ahead before appointment so they can have headphones available even for a CT with having hyperacusis. With headphones for a CT, you will only hear whisper level noise. Bring notes, such as what you wrote above with you when seeing the radiologist.

Anything that messes with the complex muscles and bones that make up your jaw could cause popping or clicking, but before we discuss this, get your neck examined.