This report (click here to download the PDF file) describes how a 65-year old woman was cured of her pulsatile tinnitus in 2005. 

The cause: chronic subclavian artery occulsion. 

Her pulsatile tinnitus was just on her left side, and it was objective, which means that others could hear it.  As we've reviewed here before, objective pulsatile tinnitus is more rare than subjective pulsatile tinnitus. The doctors in this article concluded that this may very well have been the first reported case of objective pulsatile tinnitus caused by chronic subclavian artery occlusion.

This report (like most of them) is heavy on medical lingo, so review it with a doctor.  However, some things are easy to understand, like accompanying symptoms she had in addition to the whooshing:

• vertigo (which was later concluded to be a result of a blood pressure issue related (also) to the underlying cause of pulsatile tinnitus);
• the whooshing stopped when she pressed on her neck on the side of the whooshing.

Also, MR imaging did NOT reveal her problem.  And her previous doctors, who presumably gave up on her case or didn't recognize a link between her symptoms and the actual cause, prescribed "Aspirin therapy."

A cerebral angiogram revealed the underlying cause and enlightened doctors to possible solutions. If you're a doctor, check out the images in this case report... they look pretty interesting and insightful.  

An endovascular procedure was done to correct the underlying cause, and when the patient woke up, she was whoosh-free. Hooray, another cured whoosher!!

The doctors sum up:

Pulsatile tinnitus, also called vibratory tinnitus, manifests as an intracranial murmur, synchronous with the heartbeat. It can become significantly disturbing for a patient, and in some cases, it may be the only diagnostic clue to a potentially devastating or life-threatening disease, such as a dural arteriovenous fistula with cortical venous drainage. (emphasis added)

It should be noted that there are many possible underlying causes of pulsatile tinnitus, most of which are not life-threatening.  But it's important to get the bad stuff ruled out. The doctors in this report performed an angiogram specifically, they said, to "exclude a dural arteriovenous fistula (DAVF)." 

It turned out she didn't have a DAVF, but, as the angiogram was performed, the doctors found something else and, even more importantly, could figure out a way to fix the problem.

We now have links to this and over 30 other cured pulsatile tinnitus stories on our Cured Whooshers page. 

Anyone who tells you there's no cure for pulsatile tinnitus before exhausting diagnostic tests has some reading to do!

Source: "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 File)

(Only the abstract/summary is available here... ask your doctor for access to the entire article)

This patient was a 70-year old woman with unilateral (one-sided) pulsatile tinnitus in 1989. 
Her underlying cause, internal carotid artery stenosis, was identified and treated.  Her pulsatile tinnitus was cured. 

Since 1989, there have been other case reports about similar underlying causes, some of which we've posted on our Cured Whooshers page, like this one.  The underlying causes were similar, but the approaches for treatment were different.  The results were the same though: the pulsatile tinnitus was relieved!  No more whooshing!

Now that we have the Internet (i.e. easier access to more reports of varied approaches to treatment of the same condition) it's to our (and our doctors') benefit to review as much as we can to make informed decisions about best options for our individual cases.

Even though it's older (Oh how I miss the 80's! Good times!), this particular medical report's title caught my eye for a couple of reasons. 

First, I had never heard of the procedure that this patient had to correct the carotid artery stenosis, a carotid endarterectomy, so I looked it up, and learned a bit about it. 

Secondly, I was struck by the fact that this pulsatile tinnitus patient experienced SUBJECTIVE pulsatile tinnitus, which means that only the patient could hear the noise, and that the doctors decided to include that very important detail in the title.  

I think it's an important detail because of the widely accepted myth that pulsatile tinnitus is always objective (patient and others can hear it).  In fact, objective pulsatile tinnitus is more rare than subjective pulsatile tinnitus. PULSATILE TINNITUS CAN BE OBJECTIVE OR SUBJECTIVE.

Since only the abstract is available online, ask your doctors if they may be able to access the full report.  The authors' names (they are doctors) and other information is below.  

Source: "Subjective pulsatile tinnitus cured by carotid endarterectomy. A case report," Louwrens H.D.; Botha J.; Van der Merwe D.M., South African Medical Journal, 1989.

I love to see a medical report with "Pulsatile Tinnitus" in the title, don't you?

This medical journal report titled, "CT Angiography as a Screening Tool for Dural Arteriovenous Fistula in Patients with Pulsatile Tinnitus: Feasibility and Test Characteristics," was published very recently in the American Journal of Neuroradiology.  The report explores the effectiveness of a specific diagnostic test -- a CT angiography (CTA) -- compared to a cerebral angiogram, for pulsatile tinnitus patients whose cause is determined to be dural arteriovenous fistula. 

There is a lot of medical terminology in the piece, so be sure to review it with your doctors.  

A CTA is a less-invasive diagnostic test than a cerebral angiogram. What does this mean?  Less-invasive typically means less risk, less discomfort, less hassle. Naturally, the decision to have either test should be thoroughly discussed with our doctors.

It should be noted that dural arteriovenous fistula is just one of many possible underlying causes of pulsatile tinnitus.  But information like this may be very helpful to doctors and patients in the consideration of diagnostic test options.

It would be great to see more studies about the effectiveness of the CTA and other diagnostic tests, specifically their success (or lack therof) in revealing other possible pulsatile tinnitus causes.

A link to the abstract (summary) can be viewed HERE.  

Whooshers: like most of the medical journal reports linked to on our Cured Whooshers page, this one is quite complex, so definitely review this case with your doctors. 

We know that, sometimes, pulsatile tinnitus patients endure simultaneous symptoms and health problems that may or may not be related to the pulsatile tinnitus symptom.  

The patient in this report titled, "Resolution of Pulsatile Tinnitus Following an Upper Mediastinal Lymph Node Resection," was a 56-year-old woman being treated for "a metastatic mid-gut carcinoid tumor." She was diagnosed with the cancer, but doctors were not convinced that her pulsatile tinnitus was related.  She suffered from pulsatile tinnitus for seven years and underwent many of the same diagnostic tests that most pulsatile tinnitus patients undergo, all of which returned "normal" results (sound familiar?).

After exhausting all the tests, our fellow whoosher (quite understandably) gave up on ever finding the cause of her PT.

Turns out, as doctors discovered in later treatments of the cancer (one called gamma probe detection), the tumor affected her lymph node, which was determined to be a likely cause of her pulsatile tinnitus. 

"We report, to our knowledge, the first case of metastatic carcinoid tumor with external compression of the left vertebral artery as a cause of seven-year-long unilateral persistent pulsatile tinnitus."

To make a very long story short, the doctors fixed the lymph nodes surgically (in what the doctors describe as a "simple" procedure), and her pulsatile tinnitus went away.

"When the patient awoke from anesthesia, she immediately noticed that her pulsatile tinnitus was gone."

THE CULPRIT:

"Final pathology revealed a 25 x 18 x 10 mm superior mediastinal lymph node that was almost completely replaced by a metastatic carcinoid tumor. A total of 6 metastatic lymph nodes were identified within the scalene fat pad. A follicular adenoma with cystic degeneration was found in the right thyroid lobe."

Another Whoosher cured!

Doctors in this case concluded that this was the first reported case of pulsatile tinnitus being caused by these specific effects of a metastatic carcinoid tumor: 

"We believe a careful search for nodal metastases compressing vascular structures in such patients is warranted as debilitating pulsatile tinnitus may be cured by a simple surgical procedure."

Since I'm not a doctor, I won't pretend to understand half of what is reported on the pages of this report. There are pictures, which is nice, but do I understand them or know how to interpret them?  Nope.

However, I did understand some key points in the report.  Like:

"Pulsatile tinnitus is often a chronic, disabling condition, in which the etiology may be elusive."

[Um, yes, elusive, indeed.]

"Although pulsatile tinnitus represents only a small percentage of tinnitus cases, the majority of patients have a treatable underlying etiology."

Translation: Pulsatile tinnitus is rare but most patients have a treatable cause.  

That's good to read.  

Source: (Abstract) "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.

A link to the full case report is available online HERE.  

In preparation for today's post, please bear with me as I do a little required math:

60sec x 60min x 24hr x 365 days = number of seconds in a calendar year, (31,536,000)

31,536,000 seconds x 2 years = 63,072,000 seconds

1 second = 1 whoosh

63,072,000 WHOOSHES*

*When there's an increase in heart rate my whoosh increases two-fold, so the number of my whooshes is much higher.  But we're already talking tens of millions of whooshes! If only I had a dime for each one...

SIGH

Two years ago, I woke up hearing a sound that would change me.  I wrote about it last year, during my first whoosherversary, and well, it's still in my head. 

That morning, I searched "I can hear my heartbeat" on search engines to see if anyone else had similar experiences.  So many search results, I couldn't believe it!  I quickly learned that the pulsing whoosh whoosh whoosh sound had a name: pulsatile tinnitus. 

I wondered: how could I have gone this far in life and never heard of tinnitus, much less pulsatile tinnitus? 

I made appointments with ENTs, because I was hearing noises, after all.  When one ENT had no idea what my symptoms were (and suggested that I was crazy) I expanded my search: neurologists, neuro-ophthalmologists, cardiologists, neuro-interventional radiologists, neurotologists.

For the record, my health insurance -which will remain unnamed- did not have ONE neurotologist on file.  And, two years after my request that one (just one, please!) be added to my IN-network plan, that still hasn't happened. Before I found "good" ones, I saw several neurotologists (on my own dime) who were awful and did not take my pulsatile tinnitus symptom seriously.  But I digress...

I had every diagnostic test under the sun (why hello there, radiation, nice to see you again!), which created an impressive, heavy portfolio of films and reports that included a variation of words I've grown to hate: unremarkable and normal.  I keep said portfolio in a very large plastic bag, since almost every time I have to lug it around for an(other) appointment it RAINS.  Pouring rain.  Like in a Woody Allen movie or something.  True story.

The underlying cause of my pulsatile tinnitus was eventually discovered via a cerebral angiogram.  Hooray!  That was May 2009.  This made me very --happy?  Relieved, is more like it.  Nonetheless, because of the rarity of my case and the difficulty operating on the precise area of my head where the stenotic vein is, I'm still in discussions with doctors (who have never seen a case of pulsatile tinnitus caused by this, by the way) about how to safely and effectively fix it.

My restless (depressing, expensive, emotionally draining... I could go on and on) search to find doctors who take my case seriously proved to be worth the trouble.  Thank goodness!  My research and determination to be my best advocate helped me get to this point.  I know I've had successes, namely running around town (in my rain gear) until I found the right doctors to review my case in all its complexity. 

However, I've also learned my limits.  For example, I appreciate and respect that sometimes I will -and do- still have bad days.  Instead of resenting them or trying to ignore them, I simply allow myself to have them.  I don't think there's any sense in ignoring the fact that we all know: pulsatile tinnitus sucks --it really sucks.  No one who does not experience it can truly understand.  And yes, there are days when I need the world to know it. 

You can find an audio file that sounds like your whoosh and play it for others (which I highly recommend by the way), but when it comes down to it, no one but a pulsatile tinnitus sufferer knows what being a pulsatile tinnitus sufferer is really like.

Today, as I look back at the last two years, I'm tired.  Exhausted, really.  When I woke up that morning and heard the first whooshes, I had no idea that the noise would have such an impact on my life, nor that it would last this long!  My anxiety decreased significantly when the underlying cause was discovered, but I still whoosh, I still need to cope and I still hate it. 

I launched Whooshers.com in July 2009 for a variety of reasons... mainly, to convince myself (and those first doctors I saw) that I wasn't alone.  I knew there had to be other pulsatile tinnitus sufferers out there.

I was right.  So many of you have written in with your personal stories, your strifes, your good news, your requests for hopeful news, your coping tips, and referrals for doctors.  Each and every message has helped me, and I know that those posted here on the site and on our Facebook pages have helped many, many others.

As a patient, I certainly don't know all the answers... and this site is not and should never be a replacement for sound advice from a trained medical professional.  But together we're building a group that is being recognized by the medical community so that we and they may work together to help find more answers for pulsatile tinnitus patients everywhere. 

Each time a whoosher tags his or her location on our Whoosher Map, or when one more medical journal report about a Cured Whoosher is added to the page, or a Whoosher sends me a kind email to tell me that they are relieved to find Whooshers.com so they know they're not "going crazy," my heart SMILES!  And for just a second I don't focus on the whoosh in my head. 

So thank you, kind whooshers, for sharing this journey with me.  Please keep your emails, comments (available under each post on this site, even this one!), recommendations and other posts (like on our Facebook group page!) coming. 

I would be remiss if I didn't acknowledge that, this time last year, I had hoped my pulsatile tinnitus would be cured by now.  Unfortunately, today, it is not, but I haven't given up.

I won't give up.  I hope you won't either.

So, I'm going on year three of this, but many of you have been whooshing for much longer.  What do YOU do on YOUR whoosherversary?  Anything special?  I'd love to hear your ideas in the comments below. 

Whoosh Whoosh,

WhooshEr

*WARNING* Very graphic images in the links below.  Not for the queasy.  You've been warned!! 

Most of the time we find studies and reports about pulsatile tinnitus, it seems the underlying causes are invisible to the naked eye.  Well, here is a case that is actually evident in and on the patient's eye.

This study recently published in The New England Journal of Medicine reports on a case of pulsatile tinnitus caused by a carotid-cavernous sinus fistula.  The patient, a 55-year old woman, experienced pulsatile tinnitus, along with headache and other symptoms (like a painful eye, ouch!). 

After an embolization procedure (described in the study), her symptoms were improved and the pulsatile tinnitus was remedied.  No more whooshing!  And her eye looks a whole better, too!

According to the Handbook of Ocular Diseases, carotid-cavernous sinus fistula can occur as a result of head trauma or it can occur spontaneously.

A pulsing bruit (pulsatile tinnitus) is one symptom of both types of carotid-cavernous sinus fistula. 

Interestingly, the Handbook of Ocular Diseases says: "Practitioners in virtually every medical specialty will misdiagnose the first case of low-flow dural CCSF that they encounter." (emphasis added)

If you experience the symptoms described above, it may not hurt to share and review this report with your doctors.  

See this and many other links to medical journal reports of patients who were cured of their pulsatile tinnitus on the Cured Whooshers page.  

Source: 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.