Pulsatile Tinnitus: Any Suggestions for Doctors / Hospitals in Melbourne/Australia?

[Shreya]

Hi,

Started having pulsatile tinnitus in right ear since last week (sudden, no previous conditions/injury/surgery/trauma). However, I am usually very stressed (work, etc.).
It stopped for 3 days in between and came back again today.
Initially my GP suggested antibiotics as she could see some redness in the ear. Antibiotics over now. My GP has asked for an audiology test, from which I am not expecting much, having studied about this problem.

I am planning to ask for referrals to neuro / ENT and scans / MRA.

In the mean time please provide suggestions on how to cope with this while going on with work and daily life?

Also anybody based in Melbourne/Australia, could you suggest which doctors/hospitals to see? I am from here.

I am extremely nervous. Any help much appreciated. Thanks.

 

[Shreya]

Just commenting so that someone replies. Please help. Anything.

 

[Shreya]

Hi,

I cannot reply to personal conversations. Can anyone help, please?
@DebInAustralia

 

[Shreya]

Hi all,

I saw a neurologist first (I just got a referral to first see a neurologist only - not a neuro interventional radiologist) after the ENT surgeon. Got a CT angiogram done first. Neurologist suspected a dural AVM from the CT angiogram. Then got an MRI/MRA done.

The neurologist says that the scans are not conclusive and some vascular malformation like a dural AV fistula may be present, but they are not sure. After consultation with a radiologist and based on my symptoms, they are suggesting an angiography.

I am scared of the angiography as it comes with the complications, while they are not sure whether it is a dural AV fistula at all.

Should I get a second opinion before I get the angiography? Please provide your suggestions.

The coronavirus situation is making things worse - like getting an appointment or a scan booked.


@tiniturtle @Greg Sacramento

 

[Greg Sacramento]

Hello @Shreya

I have pulsatile tinnitus - blockage in carotid and internal jugular with thumping and humming. I can't be operated on because of a bad heart, kidney and other health problems at my age.

@tiniturtle has personal experience with what you mention. I did have coronary angiography many years ago and had no issues - it went smooth.

Hugs - Greg

 

[tiniturtle]

@Shreya

The angiogram is the definitive way to determine if you have a DAVF. It's really a piece of cake. I've had numerous already. The risk of complication is present, but it's pretty low. But, it's not like an MRI. The skill and knowledge of the surgeon performing the angio really matters. That will give you the best images, as well as being the safest. It's important to not go to just anyone, but the best that you can. But, you should definitely have the angiogram. After you find a doctor you're comfortable with doing this, then you use the angiogram images for your 2nd opinions.

 

[Shreya]

Thanks @Greg Sacramento and @tiniturtle.

 

[DebInAustralia]

Thanks @Greg Sacramento and @tiniturtle.

Hey Shreya,

I was thinking about you.

Saw you're looking at a 2nd opinion.

Are you still working at Melbourne uni?

 

[Shreya]

Hi @tiniturtle @Greg Sacramento
I had my angiography. Both the doctor performing it, and my neurologist now say there is no DAVF.
They initially said it looks like DAVF from the MRI/MRA.

The sound is still there (I would say less frequent, and related to my anxiety levels). For example, on the day of the angiography, I was relatively more stressed, I could hear it very loud and multiple times during the day. It happens with days I have stress at work too. But you cannot live without a little bit of anxiety, can you? The doctor has prescribed anti-anxiety pills and anti depressants. I'm not sure what to do as the sound is still bothering me. They said it is unknown to them what is causing the sound, but it cannot be life threatening so I should focus on getting rest and see how I am for 2-3 months.

Can anxiety cause pulsatile tinnitus?

 

[Greg Sacramento]

Hi @Shreya:

Can anxiety cause pulsatile tinnitus?

Yes. To view thoughts with links and personnel experiences - place hypertension into search on this page or home page.

This would be impossible to quickly summerize, but at your age, disease may not be cause such as cogged arteries, heart disease, abdominal aortic enlargement, etc. The thyroid can sometimes be a problem.

Sometimes too much vitamin A can cause hypertension PT.
Blood tests.
Monitoring of blood pressure when feeling high anxiety.
Pulse monitoring.

The doctor has prescribed anti-anxiety pills and anti depressants.

60% with PT, do have anxiety - so medication should help.

 

[Shreya]

Thanks, @Greg Sacramento.
My blood tests have been normal. My blood pressure is a little low (especially after the angio).
However, I agree I am stressed.
The thumping and the sound is so irritating and loud sometimes, it is hard to believe for me that there is no underlying cause. It's so frustrating that after all these numerous tests it remains unexplained. Is there anything else I can do? Other than taking the medications (To be honest, I'm scared of anti-depressants because of their side-effects)?

 

[Greg Sacramento]

@Shreya You seem to be in good health. You haven't mentioned any other concerning ailments. You mention redness in right ear where you have on and off PT.

Low blood pressure can cause ear redness easily. The redness is usually caused by small nerve fibers and this is a common sign of low BP and that can cause PT. Your blood tests and use of antibiotics should rule out infection. Your three other radiological tests would rule out a lot of things.

You are too young for many central vascular concerns. Using the word central, instead of a lot of medical terms that I doubt would apply to you. The cause of your low blood pressure with consideration to no radiological and blood test findings, may be just stress. Most likely, a parent, aunt or uncle also has slightly low blood pressure.

Keep a record of BP testing and post results if you wish. Test sitting, standing and laying down. You can place your BP results into an internet search. Example - place - BP 120/90. All sites will tell you about your ratings. I doubt that you have hypotension which is constant low blood pressure. Most sites will not go into possible cause details. The American Heart Association has lobbied against this because they don't want over reaction which is not good for those with abnormal blood pressure.

Your mention of redness in right ear with PT is a strong sign that you are having blood pressure changes. This may indicate that stress is causing PT thumping and not another condition.

One way to determine is to lower stress - by medication or other means, but your on and off PT may be just stress. There are many ways to lower BP stress - some work for some and some work for others. Vitamin use for some can increase stress.

 

[tiniturtle]

Hi @tiniturtle @Greg Sacramento
I had my angiography. Both the doctor performing it, and my neurologist now say there is no DAVF.
They initially said it looks like DAVF from the MRI/MRA.

The sound is still there (I would say less frequent, and related to my anxiety levels). For example, on the day of the angiography, I was relatively more stressed, I could hear it very loud and multiple times during the day. It happens with days I have stress at work too. But you cannot live without a little bit of anxiety, can you? The doctor has prescribed anti-anxiety pills and anti depressants. I'm not sure what to do as the sound is still bothering me. They said it is unknown to them what is causing the sound, but it cannot be life threatening so I should focus on getting rest and see how I am for 2-3 months.

Can anxiety cause pulsatile tinnitus?

The short answer is no. You probably have some sort of mild physical abnormality that is causing it. If it isn't dangerous, don't worry about it. Before you get to that point though, I would get a second opinion. Have someone else look at your images and the angiogram. If they say the same, then try to put it behind you.

 

[Greg Sacramento]

@Shreya
Just alternative thoughts.
Your doctors feel that your thumping may have association to stress. Having ear redness may be key consideration and of a stress mechanism that may be causing your thumping. Your ENT was not able to find an ear problem, but did consider possible infection so antibiotics was given.

You have also mention that you can go days without thumping, but when under stress it can become loud. Red ear internally can be caused by ear muscles and nerve interaction when under stress. There are several external possibilities with that and thumping and one could be jaw pressure - pressing together.

Can say if there's not a vascular reason. Red ear can expand vein and arteries in the neck. Flushing, blushing and thumping are common with red ear. Red ear can also be caused when blood flow in the ear area changes. With red ear, nerves can reach back to the C spine. Ear nerves also connect to a branch of the trigeminal nerve.

Stress that builds up at the later part of the day can play a part in all of this. Maybe a little tea or break time towards the end of your workday will help. Your red ear can just go away and then the thumping with that within weeks. Any prior ear infection may also take a few weeks for things to settle.

 

[Shreya]

@Shreya
Just alternative thoughts.
Your doctors feel that your thumping may have association to stress. Having ear redness may be key consideration and of a stress mechanism that may be causing your thumping. Your ENT was not able to find an ear problem, but did consider possible infection so antibiotics was given.

You have also mention that you can go days without thumping, but when under stress it can become loud. Red ear internally can be caused by ear muscles and nerve interaction when under stress. There are several external possibilities with that and thumping and one could be jaw pressure - pressing together.

Can say if there's not a vascular reason. Red ear can expand vein and arteries in the neck. Flushing, blushing and thumping are common with red ear. Red ear can also be caused when blood flow in the ear area changes. With red ear, nerves can reach back to the C spine. Ear nerves also connect to a branch of the trigeminal nerve.

Stress that builds up at the later part of the day can play a part in all of this. Maybe a little tea or break time towards the end of your workday will help. Your red ear can just go away and then the thumping with that within weeks. Any prior ear infection may also take a few weeks for things to settle.

Hi @Greg Sacramento the ear redness and infection (if any) was temporary and long gone. Right now the only major problem is the on and off tinnitus in the right ear. Thanks a lot for the suggestions

 

[Shreya]

The short answer is no. You probably have some sort of mild physical abnormality that is causing it. If it isn't dangerous, don't worry about it. Before you get to that point though, I would get a second opinion. Have someone else look at your images and the angiogram. If they say the same, then try to put it behind you.

Thanks, I feel the same. Yes, I need to get a second opinion.

 

[Semperv]

Thanks, I feel the same. Yes, I need to get a second opinion.

Hello Shreya,
Did your symptoms resolve?

Regards,
B.

 

[Shreya]

@Semperv sorry for the late reply.

My condition has not completely resolved, but I am feeling better. I continue to use music (white noise) while working in a silent room and during sleep so that I am not distracted (in case I hear the sound, which is very less frequent nowadays). This helps to keep my anxiety low and consequently is probably improving the situation. Having said that, I do live in constant fear that the tinnitus will recur in full swing, as it has not completely gone away. The doctors have asked me not to worry and go back to them if and when conditions deteriorate, as there is nothing to be done in their opinion currently. I had gone to a interventional neuroradiologist for a second opinion, and he also confirmed from the angiogram, MRI/MRA that there is no DAVF but a normal variant of blood vessels in my right (which may or may not be causing this) which needs no surgical action right now.

Hope that helps.