A case of possible pulsatile tinnitus presenting as auditory hallucinations

Pulsatile tinnitus (PT) is a rare form of tinnitus affecting 3-5 million Americans characterized by the perception of a rhythmic sound. Diagnosing PT in the clinical setting is important, as it is commonly caused by underlying vascular pathologies (i.e., arteriopathies or venopathies) leading to an increased risk of stroke, blindness, or deafness, though identifying it presents a challenge due to the broad depiction of PT's distinguishing auditory perception (Narsinh et al., 2022). As such, atypical presentations of PT may be misdiagnosed as other neurologic or psychiatric disorders. Here, we present a case where pulsatile tinnitus took the form of debilitating auditory hallucinations ultimately requiring inpatient psychiatric hospitalization, demonstrating the importance of a thorough evaluation and multidisciplinary consultation in the workup and long-term care for these patients.