Question: I've seen references to pulsatile tinnitus as being almost a medical emergency - possibly caused by a tumor or an anuerism that could lead to stroke. Other places it's presented as annoying but not dangerous. I went to an ENT who did hearing tests (normal) and said he could send me for an MRI but felt it was unecessary. On one web site I was looking at recently, posted was a response to someone with pulsatile tinnitus from an MD who suggested an angiogram be done. The person had already had an MRI which was negative. This was kind of alarming to me. Frankly, the pulsing in my ear is less of a concern to me than the notion that it is indicative of a serious health threatening condition. I've had this for only a few months. Have people out there with pulsatile tinnitus done MRI's MRA's and angiograms? I'd really appreciate any responses.

Answer: When tinnitus is "pulsatile" it means that some component of the tinnitus sound (if not the entire tinnitus sound) is due to blood flowing through blood vessels. Since blood is pumped out of the heart in rhythmic pulsations, blood flowing through the vascular tree - if audible - tends to have a pulsatile quality.

The vast majority of pulsatile tinnitus is "innocent," meaning that it - just like the vast majority of non-pulsatile tinnituis - is *not* caused by something that is a threat to life or physical health.

Whether or not to do an MRA or even a cerebral arteriogram on a patient with pulsatile tinnitus depends upon numerous factors in the history, physical examination, and audiological evaluation - chapters have been written on the topic! It is those factors (contributing to your doctor's "index of suspicion"), not merely the *presence* of a pulsatile component to the tinnitus ... that dictate whether or not further testing (e.g., MRA or arteriogram) might be indicated.