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.

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.

1. 01Up to 50% of pulsatile tinnitus cases have no identified cause (idiopathic).
2. 02