Eagle Syndrome May Result in Pulsatile Tinnitus

[Russell Grimes]

There are no posts regarding Eagle Syndrome on this forum. However, an elongated and calcified stylohyoid ligament can cause compression of the carotid artery and subsequent pulsatile tinnitus. It is possible some people who visit this forum may have this condition. The following is a link to an enlightening article regarding the aetiology and symptomatology of Eagle Syndrome.

 

[Greg Sacramento]

There are no posts regarding Eagle Syndrome on this forum.

There's several posts that discuss Eagle Syndrome. I posted about the variations of this condition. Nerve involvement would be somatic physical (facial, mouth, throat and neck movement) - I always consider this.

Condition vessel involvement from movement and blood flow may be an indication for pulsatile tinnitus - rare. Eagle Syndrome resulting from blood vessel compression is more likely to cause a severe headache than neck pain. Since there's many conditions that can cause headaches, a list of factors must be considered including blood flow and hypertension blood pressure.

With suspect conditions that may have some relation to either somatic physical tinnitus or pulsatile tinnitus, a CT is needed. Treatment success for pulsatile tinnitus is 80% to 100% and for somatic physical tinnitus at least some relief can often happen.

 

[Russell Grimes]

There's several posts that discuss Eagle Syndrome. I posted about the variations of this condition. Nerve involvement would be somatic physical (facial, mouth, throat and neck movement) - I always consider this.

Condition vessel involvement from movement and blood flow may be an indication for pulsatile tinnitus - rare. Eagle Syndrome resulting from blood vessel compression is more likely to cause a severe headache than neck pain. Since there's many conditions that can cause headaches, a list of factors must be considered including blood flow and hypertension blood pressure.

With suspect conditions that may have some relation to either somatic physical tinnitus or pulsatile tinnitus, a CT is needed. Treatment success for pulsatile tinnitus is 80% to 100% and for somatic physical tinnitus at least some relief can often happen.

Thanks for the response, Greg. I have clicking in my throat when swallowing, transient pain in one ear that feels like it is referred from my spine, and pulsatile tinnitus that worsens with movement in the other ear. With a clear MRI/MRA of skull base, brain, and neck I think it might be time for a CT scan. I know I can find the etiology of my problems but it will require help from doctors. Given the current sad state of medical care in the United States getting a diagnosis for pulsatile tinnitus is harder than ever. I worry most about spontaneous vertebral or carotid artery dissection.

My problems started in January. I still have not died, obviously, and can still run but this condition has reduced my quality of life. I do not get dizzy but I feel blood rushing to my head and about 5-7 seconds of intense whooshing, especially after changing positions like rolling over in bed or standing. When running, I can hear the whooshing but I am unbothered by it.

 

[Greg Sacramento]

I do not get dizzy but I feel blood rushing to my head and about 5-7 seconds of intense whooshing, especially after changing positions like rolling over in bed or standing.

It wuld be dilation of blood vessels which involves a change in blood vessel diameter. This is most always rapidly followed by a return to normal - 10 seconds or less. Turning or tilting head in a certain angle and pressing finger against one specific artery on side of neck, pulsatile tinnitus increases suddenly.

Several things could be causing this without dizziness. Some are:

Strain in cervical vertebral area - OK, that's a given.

Nerve roots trauma near cervical vertebrate, possible - and more so, with cervical facet joint strain.

Loss of function involving the lower cranial nerves (IX-XII). With this, some patients have cervical carotid artery dissection, but would need a headache. I doubt this for you.

Slightly straightened C-spine - placing pressure on vertebral arteries.

Fibromuscular dysplasia.

Muscular branches of the occipital artery, which developed to supply the distal vertebral artery after subclavian artery occlusion.

*Possible cause is a shortened hyoid muscle that is causing a click during swallowing. A CT scan would be needed to confirm normal anatomy of this and other muscles around the neck. Probably the most common cause of the development of a clicking noise in the throat would be an anatomic irregularity within the thyroid bone. This also could cause dilation of blood vessels - 10 seconds or less - with head and body position movement and/or change. Change - having been in another position for awhile.

 

[FocusRS]

Hey @Russell Grimes.

I'm glad you posted your symptoms and your post about Eagle Syndrome. I also have many of those same symptoms except the clicking in throat and current ear pain. My pulsatile tinnitus is on my right side, sometimes sounds like it's in the back of my head, and I have normal tinnitus on my left side, all starting at the same time (I think due to the erratic blood flow caused by the pulsatile tinnitus Issue). When I first got it, it sounded like an electrical storm, now it just sounds like pulsing static. The pressure in the back of my head is the worst, like you said, those loud 5-7 seconds of extreme pressure and whooshing when standing/bending over/any stressful event.

After a series of doctors, I was able to get recommended to a Neuroradiologist and had to get a CT/A, MRI/A (on at least a T3 Tesla MRI machine because normal MRI machines are not as clear), Lumbar Puncture, and Neuro Angiogram to figure it out. They were able to find bilateral high cervical internal jugular venous stenoses, with external compression from the styloid processes, and blood rerouting through the condylar venous systems - causing so much pressure. They also found a right sigmoid sinus diverticulum however they believe the compression of the jugular vein is the issue. All my other doctors missed it on previous tests, it wasn't until I found a good Neuroradiologist also called Interventional Neuroradiologist that I was able to get a potential diagnosis. I'm still dealing with it now so I understand how much it hurts the quality of life, but know you are not alone, and you will get through this.

Mine is reactive to many different things, and I was wondering how reactive is yours? Such as if you move your neck side to side or up and down, does it increase/decrease the noise level? Are there any areas on your face or neck that you can push to make the noise go up or down (especially below your ear area)? You say it's reactive when you get up from sitting and standing, how about if you hold your breath deep for 20 seconds, then let out, does that cause any pressure or noise change? I truly believe once you find a good Neuroradiologist they will be able to figure this out, make sure you ask your doctor or Neurologist for some references/referrals - normally the best ones work at university hospitals.

 

[Russell Grimes]

Hey @Russell Grimes.

I'm glad you posted your symptoms and your post about Eagle Syndrome. I also have many of those same symptoms except the clicking in throat and current ear pain. My pulsatile tinnitus is on my right side, sometimes sounds like it's in the back of my head, and I have normal tinnitus on my left side, all starting at the same time (I think due to the erratic blood flow caused by the pulsatile tinnitus Issue). When I first got it, it sounded like an electrical storm, now it just sounds like pulsing static. The pressure in the back of my head is the worst, like you said, those loud 5-7 seconds of extreme pressure and whooshing when standing/bending over/any stressful event.

After a series of doctors, I was able to get recommended to a Neuroradiologist and had to get a CT/A, MRI/A (on at least a T3 Tesla MRI machine because normal MRI machines are not as clear), Lumbar Puncture, and Neuro Angiogram to figure it out. They were able to find bilateral high cervical internal jugular venous stenoses, with external compression from the styloid processes, and blood rerouting through the condylar venous systems - causing so much pressure. They also found a right sigmoid sinus diverticulum however they believe the compression of the jugular vein is the issue. All my other doctors missed it on previous tests, it wasn't until I found a good Neuroradiologist also called Interventional Neuroradiologist that I was able to get a potential diagnosis. I'm still dealing with it now so I understand how much it hurts the quality of life, but know you are not alone, and you will get through this.

Mine is reactive to many different things, and I was wondering how reactive is yours? Such as if you move your neck side to side or up and down, does it increase/decrease the noise level? Are there any areas on your face or neck that you can push to make the noise go up or down (especially below your ear area)? You say it's reactive when you get up from sitting and standing, how about if you hold your breath deep for 20 seconds, then let out, does that cause any pressure or noise change? I truly believe once you find a good Neuroradiologist they will be able to figure this out, make sure you ask your doctor or Neurologist for some references/referrals - normally the best ones work at university hospitals.

Hi. Thanks for the response. It sounds like you received a very specific diagnosis. I am glad you were able to get such appropriate and extensive testing. What is the plan for resolution of your symptoms? Does the doctor think your situation is dangerous?

My pulsatile tinnitus is very reactive and it is the worst in the morning. For some reason when I am in bed in the morning and stretch my heart rate increases and beats hard for about 5-7 seconds and the pulsatile tinnitus in my right ear goes through the roof before going back to baseline after about 5 seconds.

If I press on my lower jaw or under my ear I get a loud screeching sound that devolves into loud pulsatile tinnitus if I maintain pressure. If I release pressure the sound gets much quieter. If I am sitting and lean to my right side like I am falling over I get a loud high pitched sound in my right ear that immediately turns pulsatile. It is clearly blood flow.

I can make the pulsatile tinnitus almost disappear if I constrict my neck muscles. By tightening the muscles I hypothesize I am restricting blood flow through a vein or artery and reducing the sound. When I release the tension the sound comes back, more loudly for about two seconds before returning to baseline. I am guessing it is loud at first because of decreased vascular pressure or a back flow of blood.

 

[Russell Grimes]

It wuld be dilation of blood vessels which involves a change in blood vessel diameter. This is most always rapidly followed by a return to normal - 10 seconds or less. Turning or tilting head in a certain angle and pressing finger against one specific artery on side of neck, pulsatile tinnitus increases suddenly.

Several things could be causing this without dizziness. Some are:

Strain in cervical vertebral area - OK, that's a given.

Nerve roots trauma near cervical vertebrate, possible - and more so, with cervical facet joint strain.

Loss of function involving the lower cranial nerves (IX-XII). With this, some patients have cervical carotid artery dissection, but would need a headache. I doubt this for you.

Slightly straightened C-spine - placing pressure on vertebral arteries.

Fibromuscular dysplasia.

Muscular branches of the occipital artery, which developed to supply the distal vertebral artery after subclavian artery occlusion.

*Possible cause is a shortened hyoid muscle that is causing a click during swallowing. A CT scan would be needed to confirm normal anatomy of this and other muscles around the neck. Probably the most common cause of the development of a clicking noise in the throat would be an anatomic irregularity within the thyroid bone. This also could cause dilation of blood vessels - 10 seconds or less - with head and body position movement and/or change. Change - having been in another position for awhile.

Hi Greg. Thank you for the thorough overview regarding possible origins for my pulsatile tinnitus. You are quite knowledgeable and I am thankful for the help as I continue what may be a long process trying to find the cause so I might arrive at a solution.

Although I fear catastrophic sequelae to the problem, some days I wish something worse would happen to me so I could get expedited medical treatment. Right now, especially being on Medicaid and in a rural area, I am having trouble getting doctors to take me seriously enough to get additional tests.

I decided to run 5 miles every day or every other day. Running does not make the problem worse. I actually feel better when I am running than I do when I am sedentary. I hear a high-pitched squeak like a bed spring with each bounce. What do you think might cause that sound? Perhaps jarring of a blood vessel?

 

[Greg Sacramento]

I hear a high-pitched squeak like a bed spring with each bounce. What do you think might cause that sound? Perhaps jarring of a blood vessel?

Your issues are very common, but there's variations - 60% or more probability. CT is needed to note any relationship(s).

Refer to my above post again and read this article given to me last night by a very qualified radiologist after a discussion.

Anatomy, Head and Neck, Suprahyoid Muscle - StatPearls - NCBI Bookshelf (nih.gov)

We can discuss variations.