What could be better than starting the year off with some excellent pulsatile tinnitus publicity?

For the second time, The New York Times has highlighted a pulsatile tinnitus case in their column, "Think Like a Doctor."  A patient's case and struggle for a diagnosis for strange symptoms that stump doctors is described, diagnostic test reports are displayed and then the comments section welcomes ideas as to what the heck may be going on to cause the patient's symptoms.  

This week's mystery was about another pulsatile tinnitus patient whose symptoms eluded even some of the best doctors around.  As you'll read, the patient had extensive diagnostic testing and a number of possible causes were ruled out.

Like many pulsatile tinnitus patients, this one went to an ear specialist after whooshing for a long time.  We know that the underlying causes of whooshing only rarely have anything to do with the ear(s) but it's completely logical for patients to start with an ear specialist.  The problem is, when the ear specialist gives us the all clear (because ear issues typically ARE absent), often we're sent on our way home without a referral to ANOTHER type of specialist to complete the warranted medical workup.  But the ear specialist in this patient's story, who realized he was stumped and had exhausted his knowledge of the culprit, did the right thing: Instead of sending the patient on his way, he referred the patient for diagnostic imaging and then to other specialists to review the patient's films.  Without the diagnostic testing, the patient would never ever have been diagnosed properly. 

But the success of a test not only depends on whether the test may detect the cause - it also depends on the eyes looking at the films.  Unfortunately for the patient, again and again, the doctors who reviewed the films gave the patient the all clear. The films were circulated some more, however, and finally a doctor isolated the causes - two of them! - and the patient was finally on the road to treatment and silence.  

And speaking of the patient, whose identity was obviously not revealed in the story, KUDOS TO YOU for your persistence seeking a diagnosis and for being your best advocate.  The end of the piece indicates that it was the PATIENT, not a doctor, who self-referred to the radiologist who ended up diagnosing the cause.  Roaming around with all your films in a big place like New York City with a symptom as wacky as pulsatile tinnitus, and dragging yourself from appointment to appointment after doctors one by one tell you over and over that "you're fine" and that nothing is evident on your films, is NOT EASY.  Good for him for hanging in there.  Enjoy the much-deserved silence!

Unlike tinnitus, many causes of pulsatile tinnitus can be identified and treated.  Our mantra here on Whooshers.com is CIRCULATE YOUR FILMS! Yet again, we have a wonderful example of a patient who did just that and, because of it, is now enjoying the wonderful consequence of silence!

SPOILER ALERT: The diagnosis has been posted, and a link to the details is below.   

UPDATE: The diagnosis was twofold: Fibromuscular Dysplasia (FMD) and a fistula between the patient's vertebral artery and vein. And, unlike any other time, NOT ONE READER guessed the proper diagnoses.  The doctor in the piece did though, and the patient is now Cured Whoosher. 

You can read more about FMD and fistulas on our Cured Whooshers page, where individual medical reports and personal stories from real Whooshers are posted. 

The last "Think Like a Doctor" column that highlighted pulsatile tinnitus was just as interesting!