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Whoosh [hwoosh, hwoosh, woosh, woosh] noun 1. a loud, rushing noise, as of air or water: a great whoosh as the door opened. verb (used without object) 2. to move swiftly with a gushing or hissing noise: gusts of wind whooshing through the trees. verb (used with object) 3. to move (an object, a person, etc.) with a whooshing motion or sound: The storm whooshed the waves over the road. Also, woosh. Origin: 1840-1850; imit.

Pulsatile tinnitus is a rhythmical noise that is synchronous with the patient's heartbeat.

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Pulsatile Tinnitus, Possibly a Side Effect of Medication?

It's a question many of us ask, especially when our pulsatile tinnitus began simultaneous to use of medication, prescribed or over-the-counter.  

There haven't been too many studies on this possible relationship to pulsatile tinnitus cases, generally, but one recent study looks specifically at fluroquinolone antibiotics, a specific family of medications, and the possible relationship of their use to one specific known cause of pulsatile tinnitus: idiopathic intracranial hypertention (IIH).

This recent study looks at a variety of the drugs in this category, including Levaquin.  This summary reveals the process by which researchers searched databases for patients whose files indicated within a short period of time the ICD code for IIH, imaging and other diagnostic testing that would confirm an IIH diagnosis, as well as a prescription for the drugs within 15-30 days of the IIH diagnosis.

Basically, the study suggested an increased risk of IIH for users of this family of medications.

These medications are no stranger to lawsuits, apparently.  Just Google "Fluoroquinolone Litigation" and you'll see the reports.   

Now that pulsatile tinnitus has its own ICD code, the potential for monitoring our cases has improved. SO MUCH. However, we see even in this report that pulsatile tinnitus is mentioned at the beginning of the abstract but then, it seems, it is referred to as tinnitus at the end of the abstract.  Pulsatile tinnitus is not tinnitus!

It may take a while for the pulsatile tinnitus code to be integrated generally and in similar research studies, but we see in this study the signficance of proper identification of symptoms to research, and the possibility that medications may play a factor in some pulsatile tinnitus cases, at least as they relate to this possible underlying cause.

As usual, consult a doctor with any questions about medications.

Source: Oral fluoroquinolones and risk of secondary pseudotumor cerebri syndrome; Mohit Sodhi, BSc, Claire A. Sheldon, MD, PhD, Bruce Carleton, PharmD and Mahyar Etminan, PharmD, American Academy of Neurology, Jul 2017.
Wed, August 2, 2017 | link          Comments

Texas Reporter Shares Her Pulsatile Tinnitus Story and Diagnosis: Chiari Malformation

Click HERE to read her interesting story about being diagnosed with Chiari Malformation, one possible pulsatile tinnitus cause.  It all started with pulsatile tinnitus...

Jenni, thank you for sharing your story and for increasing awareness of our symptom and for Chiari.  We wish you the best as you return to work!

If you are in the Austin, Texas area and reading this in late July 2017, she'll be sharing more of her story on the air July 29 and 30, 2017. 

For more information about Chiari see:

The Chiari Institute

Chiari Connection International

If you are experiencing pulsatile tinnitus, don't forget that there is a large community of pulsatile tinnitus "Whooshers" on our active Facebook group page, including some diagnosed with Chiari.  You're not alone!

Wed, July 26, 2017 | link          Comments

Learn More About Fibromuscular Dysplasia (FMD)!

I'm happy to be speaking about pulsatile tinnitus in Cleveland this weekend at the 10th Annual FMDSA Meeting!  Learn more about Fibromuscular Dysplasia, one possible cause of pulsatile tinnitus.  Click the informative video link below.

“What you need to know about Fibromuscular Dysplasia (FMD)”

Wed, May 17, 2017 | link          Comments

Best Pulsatile Tinnitus Cartoon Ever

 Thanks to a fellow Whoosher in our active Facebook group page for sharing this cartoon!

BatManWhoosh.jpg

Thu, March 2, 2017 | link          Comments

How To Listen for a Bruit Using a Stethoscope

ListenToWhooshWithStethoscope 

Pulsatile tinnitus may be subjective (only the patient can hear it) or objective (the patient AND others can hear it).

Sometimes objective pulsatile tinnitus can be heard with a stethoscope.

Sometimes it can even be heard without a stethoscope, just by putting your ear next to the pulsatile tinnitus patient's head. 

It is repeated in the medical literature that doctors should try to listen for the bruit (the sound) when a patient presents with pulsatile tinnitus.  Sometimes where the sound is located can be a clue as to the source. At the very least, hearing the sound gets the attention of medical professionals and may speed up the inquiry as to the cause. 

The right spot for the stethescope bell will vary by the patient, as the location of the source of the pulsatile tinnitus differs from patient to patient. 

Here is a very helpful post with images from "Kate," one of the members of our very active Facebook group page, republished with her permission, on how to listen for the bruit with a stethoscope:

"I made this to show where my bruit can be heard on my skull. 
 
In December 2016 I was told by an ER doctor, when I asked him to listen to my skull,
 
"We don't listen there. There's nothing there to listen to." 

He would only auscult my carotid on my neck and then told me my symptoms could be Meniere's or multiple sclerosis and they can't do much for me except refer me to an ENT. 

My personal experience/tips, as I am not a medical professional so I'm just sharing what worked for me to find the objective noise:

The stethoscope is a pediatric stethoscope. The person I borrowed this from let me try their fancy top brand cardiac stethoscope but the pediatric one worked best. It helps to press firmly but not too firmly. The sound volume changes with pressure. I can find it easily but in noisy doctor offices it can be harder to hear and especially if the person listening just quickly places the bell and moves it. It's louder in certain spots so patience and careful listening for at least 10 seconds in each spot is important in my opinion. Also, doing jumping jacks to make it louder helped my doctor the first time to find it. The second time she didn't need me to do jumping jacks because she knew what she was listening for. 

As Whoosh Whoosher has said, not everyone with PT has objective PT/bruit and the absence of one doesn't change the validity of your PT. Docs should take all PT seriously. In my experience, finding the bruit just really helped as far as having them take it seriously and sped up the process. 

Make sure you check with different postures and head positions in case the whoosh varies by these factors. For example, mine is usually silent/quiet/gurgly when laying flat, louder when tilting head to opposite shoulder of PT ear and quieter when tilting head to PT ear.
 
I really think the important things are to have a silent place to listen, a patient listener, and a good, smaller-sized stethoscope (which also helps very specifically locating the loudest point). 

Other factors, once I found my whoosh, that I noticed influence the sound are things like valsalva maneuver, holding breath, pressing artery/veins, etc. I've experimented with pressing on my carotid and jugular on both sides as well as the blood vessel on the back of my neck which I think might be the occipital artery. 

I am hoping this information will be useful for the doctors and perhaps clue them to anatomical areas to focus on when looking at my scans."
 
Be sure to see the Sounds page on this site for more images and links to audio of real whoosh sounds, recorded by real whooshers! 
Sat, February 25, 2017 | link          Comments

Peter Mansfield, M.R.I. Pioneer and Nobel Laureate, Dies at 83

Sometimes it's easy to forget that we are indebted to some of the pioneers in medicine who take a chance and create something that will endure their lifetimes and help more people than they ever could have imagined!

Sir Peter Mansfield, whose research led to the invention of MRI, died February 8, 2017.

While an MRI can't detect each and every possible cause of pulsatile tinnitus, it can detect many of them.  A number of people in our community, including Yours Truly, are pretty glad Sir Mansfield was born! 

Read more about Sir Peter Mansfield's amazing life and discoveries here, from the New York Times.

"Peter Mansfield, M.R.I. Pioneer and Nobel Laureate, Dies at 83," New York Times, February 11, 2017. 

Sat, February 11, 2017 | link          Comments

"Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up"

Here is a report to start off the new year!  A few things to take away, which we already knew but are nicely laid out in the report:

*Over 70% of pulsatile tinnitus causes can be identified. 

*High resolution machines should be used if possible. 

*No single modality (test) can rule out every possible cause.   

"Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up," Pegge, S.A.H., Steens, S.C.A., Kunst, H.P.M. et al. Curr Radiol Rep (2017) 5: 5. doi:10.1007/s40134-017-0199-7

Tue, January 31, 2017 | link          Comments

UCSF Pulsatile Tinnitus Research Study Survey

If you are a whoosher over the age of 18, please complete THIS SURVEY put together by doctors at the UCSF Pulsatile Tinnitus Clinic.  It only takes about 10 minutes!

From the survey page: 

We are conducting this survey to better understand the impact that pulsatile tinnitus has on people's lives in terms of depression, anxiety, and function. We hope that this information will help guide us in terms of providing better care for our patients and raising awareness of pulsatile tinnitus as an illness.  

Sat, December 3, 2016 | link          Comments

SleepPhones Holiday Sale!

Use code SILENTNIGHT for 25% off US orders of $50 or more. Includes free shipping.  Using this link your order will provide a portion of proceeds to our Whooshers.com community!  Good through Friday, December 2, 2016!

Sun, November 27, 2016 | link          Comments

Pulsatile Tinnitus Publicity: "A Quest to Explain the Whooshing in Her Head"

This story was also picked up by PBSNewsHour.  

Great publicity for our community and for our new pulsatile tinnitus medical codes.  

Sat, October 29, 2016 | link          Comments

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RESOURCES

NEW: Click Here to Download the PDF, "Top Ten Pulsatile Tinnitus Tips for Doctors." Review it with your GPs and ENTs!

Radiation Dose Chart - American Nuclear Society (ANS) Public Information Resources Page: Click here for an interactive dose chart for various medical diagnostic tests. A downloadable and printable version is also available on this page. Discuss with your doctors.

Find a Neurotologist: American Neurotological Society (ANS) Membership Roster

Find a Neurointervention Specialist: Society of Neurointerventional Surgery (SNIS)- Click on "Physician Locator"

Find a Neuro-Ophthalmologist: The North American Neuro-Ophthalmology Society (NANOS)

Site: Neuroangio.org - Your neurovascular education and information resource. Patient Information.

UCSF Pulsatile Tinnitus Clinic

Blog: Tales From Clark Street

Presentation: "Algorithm for Evaluation of Rhythmic Tinnitus," Douglas E Mattox, MD, Patricia Hudgins, MD, Jahrsdoerfer Lecture, University of Virginia, March 25, 2010. (This link is to the abstract/summary)

Presentation: "Imaging of the Patient with Tinnitus," Mary Beth Cunnane MD, Massachusetts Eye and Ear Infirmary, Dec 2013. (NEW! Mentions Pulsatile Tinnitus and Whooshers.com. Republished with Permission.)

Article: "Imaging in Pulsatile Tinnitus: Diagnostic Pearls and Potential Pitfalls," B. S. Purohit, R. Hermans, K. Op de beeck; 1SINGAPORE/SG, 2Leuven/BE, European Society of Radiology, 2014.

Article: "Imaging In Pulsatile Tinnitus : When Should It Ring A Bell?" G. Bathla1, V. Chong; 1singapore/SG, 2Singapore/SG, European Society of Radiology, 2012."

Article: "Emma's Story," A Personal Account of Pulsatile Tinnitus, The British Tinnitus Association (BTA).

Article: "Pulsatile Tinnitus: Contemporary Assessment and Management," Aristides Sismanis, Current Opinion in Otolaryngology & Head & Neck Surgery: October 2011 - Volume 19 - Issue 5 - p 348357 doi: 10.1097/MOO.0b013e3283493fd8, Otology and neuro-otology: Edited by Myles L. Pensak.

Article: "Temporal Bone: Vascular Tinnitus," William W.M. Lo and M. Marcel Maya, Vascular, pp.1361-1374, 2003.

Article: "Diagnostic Clues in Pulsatile Tinnitus (Somatosounds)," Carlos Herraiza and José Miguel Aparicioa, Unidad de Acúfenos; Instituto ORL Antolí-Candela, Madrid, Spain; Unidad de Otorrinolaringología, Fundación Hospital Alcorcón, Madrid, Spain; Otorrinolaringología, Hospital Quirón, Madrid, Spain, Acta Otorrinolaringol Esp. 2007;58(9):426-33. This is a link to the article abstract.

Article: "How I Struggled with (PULSATILE) Tinnitus," The Story of Actor Graham Cole, Daily Mail Online, January 10, 2007.

Article: "I Got Lifesaving OP for Whooshing Thanks to US Help," David Powell, Daily Post UK, DPW West, Feb 19, 2013.

Article: "Vital Signs: An Unwelcome Ringing," by Dr. Christopher Linstrom, Discover Magazine, April 2010. (About a cured patient with pulsatile tinnitus symptoms!)

Article: "Tinnitus Highlights Poor Doctor Patient Communication," Martin Young, MBChB, FCS(SA), Diagnosis and Treatment, KevinMd.Com, November 2010.

Article: "Pulsatile Tinnitus: Recent Advances in Diagnosis," Aristides Sismanis MD, Wendy R. K. Smoker, MD, The Laryngoscope, Volume 104, Issue 6, pages 681-688, June 1994. ABSTRACT (Summary)

Article: "Neuroradiologic Assessment of Pulsatile Tinnitus," Department of Otolaryngology Head and Neck Surgery Loyola University Medical Center, Maywood, IL: Dr Kircher and Dr Leonetti; Department of Otolaryngology-Head and Neck Surgery Henry Ford Health System, Detroit, MI: Dr Standring; Presented at the Annual Meeting of the American Academy of Otolaryngology-Head Neck Surgery, Chicago, IL. Sept. 22-24, 2008. (CLICKING THIS LINK WILL DOWNLOAD THE PDF FILE)

Article: "Imaging of Tinnitus: A Review," Jane L. Weissman, MD and Barry E. Hirsch, MD, Radiology, August 2000.

Article: "Imaging in Pulsatile Tinnitus," G. Madania and S.E.J. Connor, Clinical Radiology, Volume 64, Issue 3, Pages 319-328 (March 2009).

Article: "Imaging of the Patient With Tinnitus," Mary Beth Cunnane MD, Massachusetts Eye and Ear Infirmary, December 31, 2013. (NEW! Mentions Whooshers.com and PULSATILE tinnitus as well.)

Article: "Imaging of Pulsatile Tinnitus: A Review of 74 Patients," Guner Sonmez, C Cinar Basekim, Ersin Ozturk, Atilla Gungor, Esref Kizilkaya, Clinical Imaging, Volume 31, Issue 2, Pages 102-108 (March 2007). (This is an abstract/summary-you have to pay to see the article in its entirety)

Article: "Pulsatile Tinnitus: A Review of 84 Patients," Daniel Waldvogel, Heinrich P. Mattle, Matthias Sturzenegger and Gerhard Schroth, Journal of Neurology, Volume 245, Number 3, 137-142, DOI: 10.1007/s004150050193, November 12, 1997.

Article: "Role of Angiography in the Evaluation of Patients With Pulsatile Tinnitus," Edward J. Shin, MD; Anil K. Lalwani, MD; Christopher F. Dowd, MD, Laryngoscope 110: November 2000. (PDF FILE)

Article: "Angioplasty and Stenting for Intractable Pulsatile Tinnitus Caused by Dural Venous Sinus Stenosis: A Case Series Report," Li Baomin, Shi Yongbing, and Cao Xiangyu, Dept of Neurosurgery, Chinese PLA General Hospital, Beijing, Otol Neurotol. 35.366-370. Dec 2014.

Article: "CT Angiography as a Screening Tool for Dural Arteriovenous Fistula in Patients with Pulsatile Tinnitus: Feasibility and Test Characteristics," J. Narvid, H.M. Do, N.H. Blevins and N.J. Fishbein, American Journal of Neuroradiology 32:446-453, March 2011.

Article: "Brain Dural Arteriovenous Fistula (BDAVF)," Patient Information, www.NeuroAngio.org

Article: "Usefulness of C-Arm Cone-Beam Computed Tomography in Endovascular Treatment of Traumatic Carotid Cavernous Fistulas: A Technical Case Report," Sato, Kenichi MD, PhD; Matsumoto, Yasushi MD; Kondo, Ryushi MD, PhD; Tominaga, Teiji MD, PhD, Neurosurgery: August 2010 - Volume 67 - Issue 2 - p 467470.

Article (Abstract): "A Convenient Sonographic Technique for Diagnosis of Pulsatile Tinnitus Induced by a High Jugular Bulb," The American Institute of Ultrasound in Medicine, Minoru Nakagawa, MD, Norimitsu Miyachi, MLT and Kenjiro Fujiwara, MD, Department of Neurosurgery (M.N., K.F.) and Clinical Laboratory (N.M.), Kosei General Hospital, Hiroshima, Japan, J Ultrasound Med 27:139-140 0278-4297, 2008.

Article: "Surgical Treatment of the High Jugular Bulb in Patients with Ménières Disease and Pulsatile Tinnitus," V. Couloigner, A. Bozorg Grayeli, D. Bouccara, N. Julien and O. Sterkers, European Archives of Oto-Rhino-Laryngology Volume 256, Number 5, 224-229, DOI: 10.1007/s004050050146 (ABSTRACT)

Article: "Brain AVM," (arteriovenous malformation), MayoClinic.com

Article: "Chiari Malformation," MayoClinic.com

Article: "Ménière's Disease," National Institute on Deafness and Other Communication Disorders (NIDCD)

Article: "TMJ Disorders," MayoClinic.com

Article: "Anemia," American Society of Hematology, Hemotology.org

Article: "Pseudotumor Cerebri," (also called Benign Intracranial Hypertension) MayoClinic.com

Article: "Pulse-Synchronous Tinnitus," The Intracranial Hypertension Research Foundation

Article: "Coarctation of the Aorta," MayoClinic.com

Article: "Man Cured of Hearing His Eyeballs Move," www.bbc.co.uk, July 27, 2011. Superior Canal Dehiscence Syndrome (SCDS)

Article: "Diagnosis and Cure of Venous Hum Tinnitus," Laryngoscope, Chandler JR, 93(7):892-5, July 1983.

Article: (Abstract) "Sinus Wall Reconstruction for Sigmoid Sinus Diverticulum and Dehiscence: A Standardized Surgical Procedure for a Range of Radiographic Findings," Dr. DJ Eisenman, Department of Otorhinolaryngology - Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Otology Neurotology, 32(7):1116-9; September 2011.

Article: (Abstract) "Awake Embolization of Sigmoid Sinus Diverticulum Causing Pulsatile Tinnitus: Simultaneous Confirmative Diagnosis and Treatment," Park YH, Kwon HJ, Department of Otolaryngology-Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea, Interv Neuroradiol. 2011 Sep;17(3):376-9. Epub 2011 Oct 17. (NEW!)

Article: "A New Therapeutic Procedure for Treatment of Objective Venous Pulsatile Tinnitus," Sanchez TG, Murao M, Medeiros HRT, Kii M, Bento RF, Caldas JG, et al. Int Tinnitus J. 2002;8(1):54-57.

Article: "Glomus Tympanicum," The New England Journal of Medicine, Volume 362:e66, Number 22, June 3, 2010.

Article: "Resolution of Pulsatile Tinnitus Following an Upper Mediastinal Lymph Node Resection," Wang YZ, Boudreaux JP, Campeau RJ, Woltering EA, South Med J. 2010 Apr;103(4):374-7.

Article: (Abstract) "Dissection of the Internal Carotid Artery After SCUBA-Diving: A Case Report and Review of the Literature," Franz Hafner, MD,* Thomas Gary, MD,* Froehlich Harald, MD,* Ernst Pilger,* Reinhard Groell, PD,w and Marianne, Brodmann* "Neurologist. 17(2):79-82, March 2011. (NEW!)

Article: "Carotid-Cavernous Sinus Fistula," Bobby S. Korn, M.D., Ph.D., and Kang Zhang, M.D., Ph.D., N Engl J Med 2011; 364:e15, February, 24, 2011. (WARNING: GRAPHIC IMAGES)

Article: "Pulsatile Tinnitus Cured by Mastoidectomy," Duvillard C, Ballester M, Redon E, Romanet P., Department of Otolaryngology-Head and Neck Surgery, Hôpital Général, Dijon, France, Ann Otol Rhinol Laryngol, September 2004.

Article: "Pulsatile Tinnitus: A Symptom of Chronic Subclavian Artery Occlusion," Marcio Francisco Lehmann, Charbel Mounayer, Goetz Benndorf, Michel Piotin, and Jacques Moret, AJNR Am J Neuroradiol 26:19601963, September 2005 (PDF).

Article: "Carotid Endarterectomy Relieves Pulsatile Tinnitus Associated with Severe Ipsilateral Carotid Stenosis," J Kirkby-Bott, H.H Gibbs, European Journal of Vascular & Endovascular Surgery, Volume 27, Issue 6, Pages 651-653, June 2004.

Article: "MR Angiography Imaging of Absence Vertebral Artery Causing of Pulsatile Tinnitus: A Case Report," *Mehmet Cudi Tuncer; **Yekta Helbest Akgül & *Özlen Karabulut,* Department of Anatomy, Faculty of Dicle University, 21280, Diyarbak¹r, Turkey.** Department of Otorhinolaryngology, Özel Diyarbakr Hospital, 21100, Diyarbakr, Turkey, International Journal of Morphology, v.28 n.2 Temuco Jun. 2010."

Article: "Endovascular Treatment of Sigmoid Sinus Aneurysm Presenting as Devastating Pulsatile Tinnitus. A Case Report and Review of Literature." Mehanna R, Shaltoni H. Morsi H, Mawad M., Interv Neuroradiol. 2010 Dec;16(4):451-4. Epub 2010 Dec 17.

"Pulsatile Tinnitus Caused by an Aneurysm of the Transverse-Sigmoid Sinus: A New Case Report and Review of Literature," Lenck S, Mosimann PJ, Labeyrie MA, Houdart E., Department of Neuroradiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France, J Neuroradiol. 2012 Oct;39(4):276-9. doi: 10.1016/j.neurad.2012.02.001. Epub 2012 Sep 29. (NEW!)

Article: "Intractable Tinnitus and Sensorineural Deafness Cured by Surgical Correction of Coarctation of Aorta," S. Rathinam, A.M. Pettigrew, J.C.S. Pollack, Interactive Cardiovascular and Thoracic Surgery 3:431-433 (2004).

Article: "Pulsatile Tinnitus," Don McFerran FRCS Consultant Otolaryngologist Essex County Hospital, Colchester, British Tinnitus Association, October 2007.

Article: "Pulsatile Tinnitus and Dural Arteriovenous Malformation (Dural AVM)," G. A. J. Morrison, The Journal of Laryngology & Otology (1989), 103:1073-1075 Cambridge University Press (ABSTRACT).

Article: "Medical Mystery: Giving Birth Didn't Ease a Woman's Dangerous Hypertenstion," Sandra G. Boodman, The Washington Post, October 17, 2011.

Article: "That Noise Wasn't Just Tinnitus," Sandra G. Boodman, Special to The Washington Post, July 7, 2009

Article: "What's That Noise In Her?" H. Lee Kagan, Discovery Magazine, January 2006. (About a patient with arteriovenous malformation (AVM) and her doctor whose patience and persistence paid off).

Article: "The 'Rare' Disease That Isn't," Thomas M. Burton, The Wall Street Journal, June 27, 2009

Article: "Diseases and Conditions/ Fibromuscular Dysplasia (FMD)," Cleveland Clinic. Lists symptoms, details, treatments, and resources including Whooshers.com.

Article: Unraveling Pulsatile Tinnitus in FMD: A Report of the United States Registry For Fibromuscular Dysplasia."

Video: "A Rare Disease That May Be Underdiagnosed," Thomas M. Burton, June 26, 2009 (Hear an example of a whooshing sound in this short video)

Whooshers.com Pulsatile Tinnitus Sounds (Real Ones Recorded by Real Whooshers!)

Audio: Having trouble describing the sound you hear to others? Listen to this collection of sounds that whoosh and see if you can find a match to yours! Demonstrations: Heart Sounds & Murmurs, from the University of Washington Department of Medicine

Audio: FREE White Noise from White Noise MP3s.com

Audio: SimplyNoise.com

Whooshers.com Review: SleepPhones- Soft, comfortable headphones to help mask the whoosh for a good night's sleep.

Click Here for the International Association for Suicide Prevention (IASP)

Replace "ringing" with "whooshing," and here it is: our theme song.