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Suffering from Pulstile Tinnitus. There is a small jugular bulb formation and enlarged adenoids in head and neck. Further?

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Hello,
I have been suffering from Pulstile Tinnitus for more than 2 years now. Of late the symtoms have gotten worse, but there are times when I have no tinnitus at all. I have done all the tests, including an angiogram of the carotid and jugular complexes in the head and neck. Everything has come back normal- except that there is a small jugular bulb formation and enlarged adenoids. A doppler study of the neck two years ago, showed reduced blood flow to the brain from the right hand side carotid. I am a 39 year old woman with hyperthyroidism and PCOD. No diabetes, blood pressure asthma or allergies. Taking Thyronorm 75mcg and Glycomet 250mg (for the PCOD). I am 5'1" tall and weigh 64kgs.
Posted Tue, 22 May 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 6 hours later
Hi,

Thank you for your query.

1. I am assuming that:
a. You have true pulsatile tinnitus synchronous with your heartbeat and that there are no additional sounds.
b. You ear drums are normal and your PTA (Pure Tone Audiogram) and Impedance Audiogram (Tympanometry) is normal (no middle ear problems).
c. You have Hyperthyroidism (and not hypothyroidism). Your PCOD is established and not suspected. Do you have secondary infertility?
d. Your blood pressure is within normal limits.

2. Hyperthyroidism is a cause for pulsatile tinnitus. Other common conditions which increase blood flow are anemia (low hemoglobin) and strenuous exercise. Get your Thyroid function tests done to see if the Thyronorm is adding to your problems.

3. I would rule out the following conditions:
a. Atherosclerosis (turbulent blood flow). Get a Lipid Profile done.
b. A persistent Stapedial Artery.
c. Benign Intracranial Hypertension.
d. Sigmoid Sinus Dehiscence or diverticulum.
e. Cervical spondylosis.

4. Kindly let me know the results of your investigations. This will help in suggesting further treatment.

I must emphasize that in a vast majority of patients of tinnitus, the cause is never found. However there are further treatment options.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffering from Pulstile Tinnitus. There is a small jugular bulb formation and enlarged adenoids in head and neck. Further? 3 hours later
Dear Doctor,
Thanks for your reply.
Your assumptions no 1.a,b & d are correct. I am HYPOTHYROID (not hyper, like I have erroneously mentioned above). I did have problems with conception, because apart from the PCOD and Hypo, I also had polyps both inside and outside my uterus that were removed. My first pregnancy was assisted (IUI) but my second conception was totally normal. I had C-sections for both the deliveries.

I had a complete physical done a year ago and my lipid profile was slightly abnormal with higher than desirable readings of both LDL and Triglycerides. My doctor put me on Stanlip for 3 months. ECG was normal. My weight has been steady at 64 kgs for more than 2 years now.

I will do the follow-up investigations that you have suggested, but I would really like to know, whether it is common that adults develop enlarged adenoids? Could this have any relevance to my tinnitus?

Thank you once again.

Saraswathy
 
 
Answered by Dr. Sumit Bhatti 5 hours later
Hi,

Thank you for writing back.

1. Adenoid tissue usually atrophies and disappears by the age of 12 to 15 years.

2. Significant adenoid hypertrophy is seen in less than 5% adult patients.

3. It may be related to your tinnitus if there is any due to the adenoid mass. Hence the tympanogram is important. Is your tinnitus on one side or both? If on both sides, is it unequal?

4. If you have your scan images (not the report) or an X-ray skull lateral view for adenoids, I will be able to give an accurate assessment of the adenoids.

5. The other possibility may be a Thornwaldt's Cyst.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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