Aug 31: Tinnitus is the perception of an abnormal sound by the patient that is not actually present in her or his environment. This symptom can be very distressing, especially because it can become more prominent in quiet surroundings, making it difficult for patients to fall asleep. Intractable tinnitus has been known to cause severe psychological distress. In fact, legend has it that the famous and incredibly talented artist Vincent van Gogh actually cut off his ear as he could not bear the tinnitus he experienced, which has been presumed to have resulted from Meniere’s disease.
For a young woman who presented to the ENT Department of CMRI with a history of a disturbing pulsating noise in one of her ears, life was getting difficult, more so because no one understood her agony. The persistent sound had begun affecting her everyday life, and despite seeking medical advice at multiple centres, she was unable to find a clear explanation for what she was experiencing.
The patient had been experiencing unilateral pulsatile tinnitus—a rhythmic, pulsating sound in one ear that appeared to correspond with her heartbeat. A significant clinical clue emerged when the tinnitus disappeared on compression of the jugular vein, prompting the team to investigate a possible vascular cause.
An MR venogram was subsequently performed, which revealed narrowing of the transverse venous sinus. This finding provided an important explanation for the patient's unusual symptoms and led to a prompt referral for specialised treatment.
At CMRI, Dr. NVK Mohan Consultant - Otologist, ENT and Cochlear Implant Surgeon, evaluated the patient, while Dr. Deep Das – Neurologist was involved in the subsequent interventional management. The patient underwent venous sinus stenting to address the narrowing.
Following the procedure, the pulsatile tinnitus resolved, bringing an end to the distressing symptom that had remained unexplained for a considerable period.
The case highlights an important lesson in medicine: a symptom that appears unusual or difficult to explain should not automatically be attributed to anxiety or a psychological cause. Pulsatile tinnitus, particularly when it occurs on one side and has a rhythmic, heartbeat-like quality, can sometimes have an underlying vascular cause and may require detailed neurological and vascular evaluation.
For this young woman, recognising the clinical clue and pursuing appropriate imaging made the difference between continuing to live with an unexplained symptom and identifying a treatable underlying condition.
The case also demonstrates the importance of a multidisciplinary approach, where clinical evaluation, advanced imaging and interventional expertise come together to identify and treat uncommon conditions.
At CMRI, the coordinated efforts of Dr. NVK Mohan and Dr. Deep Das helped ensure that what had initially been perceived as a potentially psychological complaint was investigated from a neurological and vascular perspective—ultimately leading to the correct diagnosis and successful treatment.
The key takeaway
Not every unexplained sound, sensation or symptom is "just stress." Persistent pulsatile tinnitus—especially when it is one-sided or synchronises with the heartbeat—deserves proper medical evaluation. In selected cases, identifying a vascular cause early can open the door to effective treatment and prevent patients from spending years searching for an answer.