Endovascular Techniques for Pulsatile Tinnitus Treatment and Outcomes

Introduction/Purpose Pulsatile tinnitus (PT) is a multifactorial symptom characterized by the perception of a rhythmic sound synchronized with the heartbeat, accounting for approximately 4% of tinnitus cases. Among its etiologies, vascular causes are the most frequent, particularly venous pathologies such as idiopathic intracranial hypertension (IIH), transverse sinus stenosis, sigmoid sinus diverticulum, jugular bulb abnormalities, and arteriovenous fistulas, where turbulent flow is transmitted through the temporal bone to the cochlea. Venous stent angioplasty has emerged as a safe and effective therapeutic alternative in selected patients. Materials/Methods Five patients were included since 2024 with a clinical history of tinnitus as the main symptom of unilateral or asymmetric venous‐vascular etiology, pulsatile in nature, associated with headache, visual, auditory, and cognitive disturbances. Physical examination findings, such as ipsilateral jugular compression maneuvers, and imaging studies, including computed tomography angiography and magnetic resonance venography, were used for accurate case selection. All cases were confirmed by digital subtraction angiography, treated with venous stent angioplasty, and evaluated for tinnitus improvement within 24 hours postoperatively. Results Five female patients were treated, with a mean age of 39 years (25‐45). The mean duration of tinnitus was 14 months (12‐18). Idiopathic intracranial hypertension was confirmed in 4 cases. Transverse sinus stenosis was present in all patients, associated in some cases with sigmoid sinus diverticulum, Pacchionian granulations, and jugular bulb abnormalities. Endovascular treatment was performed with closed‐cell nitinol stents. No major periprocedural complications were observed. Technical success was achieved in 100% of cases. All patients received dual antiplatelet therapy with aspirin and clopidogrel. At 24‐hour follow‐up, all patients showed complete resolution of pulsatile tinnitus. One‐year follow‐up is ongoing. Conclusion Venous stent angioplasty is a safe and effective treatment in selected patients with venous pathology presenting with pulsatile tinnitus unresponsive to conservative management. It offers high technical success rates, low complication rates, and significant symptomatic improvement. Prospective studies with larger patient cohorts and long‐term follow‐up are required to validate these results.