Screening Utility of Ambient Pressure Tympanometry for the Detection of Radiologic Correlates of Subjective Pulsatile Tinnitus

Objective: To determine the sensitivity and specificity of ambient pressure tympanometry (APT) for the detection of a radiologic correlate of subjective pulsatile tinnitus (PT). Study Design: Retrospective review. Setting: Tertiary care clinic. Patients: 107 adults (147 ears) with PT who underwent APT between 2021 and 2025. Interventions: Blinded audiologists classified APT tracings as pulse-synchronous or not. Main Outcome Measures: Sensitivity and specificity of APT using any radiologic diagnosis or surgeon-defined diagnosis as 2 separate gold standards. Results: Of 137 (93.2%) ears that underwent imaging, 63 (46%) had a pulse-synchronous APT pattern. Fifty-one (37.2%) had a radiologic correlate, and 65 (44.2%) were given a surgeon diagnosis. Respectively, APT sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 51%, 57%, 41.3%, and 66.2% for a radiologic correlate and were 43.1%, 54.9%, 43.1%, and 54.9% for a surgeon diagnosis. In a subgroup of 86 patients (116 ears) with a chief complaint of PT, APT sensitivity, specificity, PPV, and NPV for a radiologic correlate were 56.9%, 54.2%, 46%, and 55.2%, and for a surgeon diagnosis were 43.6%, 54.1%, 46.2%, and 51.6%. Conclusion: With a low sensitivity and specificity, APT may not be a reliable screening tool for the detection of a radiologic correlate of subjective PT. Clinicians should continue to pursue radiologic evaluation of PT despite a negative APT and counsel patients on the limits of imaging and the potential need for multiple modalities for the detection of subjective PT sources.