How To Listen for a Bruit Using a Stethoscope
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
on this site for more images and links to audio of real whoosh sounds, recorded by real whooshers!
Sat, February 25, 2017 |
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 |
How did you learn about Whooshers.com?
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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
Find a Neurotologist: American Neurotological Society (ANS) Membership Roster
Find a Neurointervention Specialist: Society of Neurointerventional Surgery (SNIS)- Click on "Doctor Finder"
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,
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
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,
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
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
Whooshers.com Review: SleepPhones- Soft, comfortable headphones to help mask the whoosh for a good night's sleep.