An evidence-based pulsatile tinnitus clinical workflow: A systematic review of literature.
João Victor Sanders, Kiffon Keigher, Marion Oliver et al.
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In 30 seconds
This systematic review examined recent literature on pulsatile tinnitus (PT) diagnosis and management to develop referral criteria for neuroendovascular teams. The authors searched PubMed/MEDLINE in February 2025 and included 26 papers. Their proposed workflow recommends referral when imaging suggests a dural arteriovenous fistula, another high-risk vascular lesion, or idiopathic intracranial hypertension; when clinical concern for a high-risk lesion persists despite normal imaging; or when PT associated with a low-risk lesion is debilitating. The review proposes a referral protocol rather than testing its clinical outcomes.
Key findings
- The review included 26 papers to inform its proposed neuroendovascular referral protocol.
- Referral is recommended if imaging raises concern for a dural arteriovenous fistula, another high-risk vascular lesion, or idiopathic intracranial hypertension.
- Referral is also proposed for persistent clinical suspicion of a high-risk lesion despite normal imaging, or debilitating PT with a low-risk lesion.
Why it matters
PT can prompt evaluation for vascular and other potentially important causes, yet referral criteria for endovascular teams are not standardized. This review offers a structured way to consider referral based on imaging, residual clinical concern, and symptom burden. Its value is as a proposed workflow to support consistent assessment, not as evidence that the protocol improves patient outcomes.
What to keep in mind
The protocol was developed from a literature review and its clinical outcomes were not evaluated in the abstract. The search was limited to English-language studies from the last 5 years and excluded case reports and small case series.