Tinnitus or arteriovenous malformation (AVM)?

[CGTMHI]

Good Morning,

I was diagnosed with tinnitus.  It was getting really loud, so I went back to the ENT.  He sent me for an MRI.  After getting the results, listening to the noise etc.,  he thinks I have AVM.  He is going to send me to and ear specialist and probably for an MRA.  When he touched my neck, with a little pressure, below the ear and just under the jaw bone, the noise goes away. He made me feel like there is nothing they can really do, and no need to loose sleep over it, however I already am because of the noise :)

I actually went on medhelp and looked up some information, but most of the AVM cases I saw were not near the ear.  

My questions are:

1) Can AVM occur in the ear and does it cause tinnitus?

2) If this is AVM, what treatments are available?

3) What type of doctor is best trained to treat this?

4) Is there anything I can do (change of diet; physical therapy, etc.) to help this condition?

5) Could this be something else (Menniere's or TMJ)?

Thank you so much for this forum!!

[ADCulpepper]

I'm had tinnitus in my left ear for 25 years and have lived with it fine. My ENT saw nothing unusual and the audiologist at the time said i had mild hearing loss etc etc. Nothing really to do about it. Everything was fine until like 4 months ago when the tinnitus in that ear changed for like 10 minutes or so to be very high pitched -- like thousands of crickets. Then the high pitch went away (leaving the regular tinnitus behind), until this morning. I woke up with the high pitch and it has come and gone all day so far -- high pitched. (The rest of the time the regular tinnitus is there.) The new sound goes away with some change in head position then it returns after 10 minutes or so. What's going on here?

[jidi]

I haven't had it treated and still have the sound.  Mine doesn't go away with head movement, but some positions change the sound somewhat. One of my earlier ultrasounds showed some slight stenosis of the vertebral artery, but I was told that it's minor--not a problem.  So the next year when I had my 4th ultrasound, I asked the technician to take a good look at that.  He spent quite a long time on it and finally detected the fistula (artery attached to vein)on the vertebral artery.  I would suggest that you ask them to forget about the carotids and check your vertebrals.  They're threaded thru the vertebrae and abnormalities are not so easy to detect without some careful and thorough examination.
My diagnosis was confirmed by a neurovascular surgeon who did an angiogram that gave some clear pictures of the AVF. I was told it's not a high risk and could leave it alone unless my symptoms get worse.
Your problem may be totally unrelated, but it sure wouldn't hurt to ask.  I've found that I need to be a little pushy to get any action.   By the way, have you ever had your neck adjusted by a chiropractor.  Careful! It could cause damage to your neck arteries!
Jill

[BabsD]

Hi Jill,

Thanks for replying to me.  How did they find finally diagnose the AVF? How did they treat your AVF?  Is your pulsating sound gone now?  I've had an untrasound of my carotids, but that didn't show anything. The pulsating sound I hear is not constant, and it seems to occur with head movements.  

Babs

[jidi]

Hi Babs
My symptoms were several years of intensifying neck and headaches and then a loud bruit (pulsating sound) that suddenly started one day five years ago and has been constant since that time.  My MRI was normal, as were my first 3 ultrasounds of my neck.  It was finally diagnosed as an arteriovenous fistula (AVF)of the right vertebral artery of my neck.
Just thought your doctor might want to consider that possibility since they often overlook the vertebral arteries when looking for the cause of the problem.  My doctor started out thinking it was ear-related--maybe a vein touching the eustachian tube or something.  
Let me know how it goes!
Jill

[CCF-Neuro-M.D.-JT]

Very to difficult to specifically comment on your case as I would have to know what the MRI showed and why the ENT feels you have an AVM. But yes, there are a number of vascular malformations that can causes pulsatile tinnitus.
1. Although technically the AVM's not really in the ear, you can certainly have one in the neck or higher up and perceive it as a whooshing sound in the ear.
2.  Depends on where it is and how big.  Some are amenable to intravascular radiological procedures while others may need neurosurgery.
3.  Would go to vascular neurosurgeon or stroke neurologist at major academic center with interventional neuroradiology.
4.  If it's an AVM, probably not.
5.  Certainly.  But again, I have no idea what the ENT saw on your films or the exam to make him think there is an AVM so I'll have to leave that to the doctors who have seen you.  Good luck.

[Croz]

Is your tinnitus episodic or constant?

[JPKRJK]

Hello Croz, it is episodic, that is why they do not think it is Tinnitus anymore, they think it is AVM.
Thanks, Cindy

[JPKRJK]

Hey Babs,

I actually originally felt like I had water in my ear, that was like swooshing, after going to 2 different ENT's I was told it was Tinnitus.  Then when the sound became unbearable (hard to fall asleep, hard to hear when I was on the phone, head sets had to go on my left ear) and a friend could actually hear the noise while we were watching TV, I went back to the ENT. He had me describe the sound, to me it sounds like when you hold a seashell up to your ear.  He sent me for the MRI and here I am!

I hope this helps, Cindy

[BabsD]

I have a pulsating tinnitus in my left ear. When I press below that ear and just under the jaw bone, the noise goes away for me also. My ENT thought it may be a patulous Eustachian tube, but my tympanogram didn't show any signs of that. I am supposed to see him again in June to possibly get an MRI.  What were your symptoms and diagnosis ?

Babs

[jidi]

Cindy,
I have had similar symptoms and finally got a diagnosis after 5 years.  If you'd like to write to me personally, my email is ***@****.
Jill

[lori0716]

Could someone tell me what an MRA and an angiogram is.
Thanks