Pulsatile tinnitus (PT) is commonly attributed to vascular etiologies; however, up to half of cases remain idiopathic. OBJECTIVES: To investigate the association between the mastoid emissary vein (MEV) and PT and to identify MEV-related factors contributing to PT.
✦ The floor
Discussion
Signed responses from readers of the wire.
Clinicians evaluating idiopathic pulsatile tinnitus should consider dilated mastoid emissary vein as a vascular cause; imaging review specifically targeting this structure may improve diagnostic yield in otherwise unexplained cases.
Identifying dilated mastoid emissary veins as an actionable vascular etiology could reduce the proportion of pulsatile tinnitus cases that remain undiagnosed, guiding targeted treatment pathways.
- 01Up to 50% of pulsatile tinnitus cases have no identified cause (idiopathic).
- 02A dilated mastoid emissary vein is proposed as a vascular source of pulsatile tinnitus.
- 03Published in Acta Otolaryngologica (DOI: 10.1080/00016489.2026.2659350).
- 04Vascular etiologies of pulsatile tinnitus are often detectable on dedicated imaging.
- 05Recognising this specific vein anomaly may open surgical or endovascular treatment options.
Dilated mastoid emissary veins can be a cause of pulsatile tinnitus.
studypartially supportedUp to half of pulsatile tinnitus cases remain idiopathic.
studysupported- PMID
- 42107103
- DOI
- 10.1080/00016489.2026.2659350.
- Journal
- Acta Otolaryngologica
- Publication type
- research_article
- Evidence level
- 4
- Population
- Patients presenting with pulsatile tinnitus of unclear (idiopathic) origin
- Intervention
- Identification of dilated mastoid emissary vein as a vascular etiology of pulsatile tinnitus
Primary outcomes
Prevalence or presence of dilated mastoid emissary vein in pulsatile tinnitus patients; Association between dilated mastoid emissary vein and pulsatile tinnitus symptoms