A patient reports unilateral pulse-synchronous tinnitus that decreases with ipsilateral jugular compression. Otoscopy is normal and there are no focal neurological signs. What is the best next principle?
The manoeuvre suggests a venous contribution but does not establish a benign diagnosis. Imaging should be selected to assess the relevant venous and osseous anatomy.
A. Offer reassurance without investigation: Persistent pulsatile tinnitus warrants investigation.
B. Perform only a pure-tone audiogram: Audiology is useful but does not define a vascular cause.
C. Start migraine prophylaxis first: This should not replace structural assessment.
D. Arrange targeted audiological and vascular/temporal-bone imaging through an ENT-led pathway: The manoeuvre suggests a venous contribution but does not establish a benign diagnosis. Imaging should be selected to assess the relevant venous and osseous anatomy.
E. Use carotid Doppler as the sole test: It may miss venous and temporal-bone causes.
If tinnitus were non-pulsatile, bilateral and associated with symmetrical hearing loss, extensive vascular imaging would be less likely to be first-line.
Draft Clinora educational material only; not official JCIE content or clinical advice.
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