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Simply: Pulsatile tinnitus - or pulse-synchronous tinnitus - is not the same symptom as the regular, more common form
of tinnitus. The differential diagnosis of pulsatile tinnitus is very different from - and much more rare than - its nonpulsatile
counterpart. Its medical workup is different as well. There is a ripe opportunity to address these diagnostic
classifications now, as the ICD-10-CM modifications are being developed for implementation in the United States on October
1, 2014, to replace the current ICD-9-CM.*
Unlike tinnitus, the underlying cause of pulsatile tinnitus may often
be identified and treated. Unlike tinnitus, pulsatile tinnitus may sometimes be cured. More than half of people with pulsatile
tinnitus have an identifiable cause. Pulsatile tinnitus may be the sole symptom of a potentially dangerous condition.
Patients with pulsatile tinnitus may not need to "live with it." Indeed, in rare cases, it is the sole symptom
of a potentially life-threatening condition that warrants prompt treatment.
In every case, pulsatile tinnitus warrants
a thorough medical evaluation to look for known, identifiable and treatable causes, and to exclude the possibility of a
worrisome problem. For these reasons, it is especially important for doctors to know how to recognize a patient who is experiencing
pulsatile tinnitus, and to adequately distinguish and evaluate the patient’s symptoms, while also acknowledging the
effects that such a symptom may have on a patient’s quality of life.
Unlike tinnitus, pulsatile tinnitus is
rarely described as "ringing in the ears." Pulsatile tinnitus may sound like a whooshing, swooshing, screeching,
creaking, clicking or other rhythmic sound. The key that distinguishes the sound from “regular” tinnitus is that
it is a pulsing sound that is in sync with the heart rate.
Without a diagnosis code, patients with pulsatile tinnitus
are being improperly classified as part of the larger tinnitus community, with whom they share few medical similarities,
resulting in unnecessarily inadequate medical attention, diagnoses, and treatments. A unique diagnosis code would appropriately
address this subset of the tinnitus community, for whom relatively little research and medical advocacy has been devoted.
Further, because the current ICD-9-CM 388.30 for "Tinnitus" includes the word "pulsations," many pulsatile
tinnitus patients have been told (mistakenly) by their medical professionals that they are suffering from "tinnitus,"
another symptom altogether. ICD-9-CM 388.31 and ICD-9-CM 388.32, for subjective and objective tinnitus respectively,
also do not acknowledge the distinctions between tinnitus and pulsatile tinnitus, while pulsatile tinnitus may in fact be
subjective or objective. In some cases, medical insurance companies - not realizing and/or acknowledging the significance
of the difference between the two symptoms - do not accept claims for extensive diagnostic testing for a patient who is
experiencing pulsatile tinnitus, because "tinnitus" is such a common symptom with no known cure. The consequences
of this to a pulsatile tinnitus patient, unnecessary at the very least, have the potential to be devastating.
A diagnosis code for pulsatile tinnitus would convey the crucial distinctions from regular tinnitus and increase awareness
within the medical community of a complex symptom that warrants special evaluation. A diagnosis code for pulsatile
tinnitus would also begin to address the symptom experienced by a worldwide community of "whooshers," many of
whom are suffering unnecessarily by virtue of being misclassified - misdiagnosed - as "tinnitus" sufferers.
Create an ICD for "Pulsatile Tinnitus," and modify ICD-9-CM 388.30, the diagnosis code for "Tinnitus,"
by removing the word "pulsations" from the description.
It should be noted that the following proposed changes
(ICD-10) to be implemented in the United States in October 2014 also do not distinguish pulsatile tinnitus from tinnitus.
Also, since pulsatile tinnitus is typically related to some kind of vascular process rather than an implication of the ear
apparatus itself, these proposed codes that refer to the "ear" are even more inappropriate than the general codes
in ICD-9 as categories of pulsatile tinnitus. For the foregoing reasons, we propose the creation of respective and
separate "Pulsatile Tinnitus" codes for each, in addition to the modification(s) to the definition of tinnitus,
so that descriptions of tinnitus sounds are not confused with the distinctive sounds of pulsatile tinnitus.
H93.11 Tinnitus, right ear (ICD-9 Codes 388.30, 388.31, 388.32)
H93.12 Tinnitus, left ear (ICD-9 Codes
388.30, 388.31, 388.32)
H93.13 Tinnitus, bilateral (ICD-9 Codes 388.30, 388.31, 388.32)
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