The radiologic evaluation of pulsatile tinnitus and the vascular tympanic membrane.

PT may be the only symptom signalling a need for imaging the temporal bone region. Since a wide variety of processes may be responsible for this symptom, the goal of the radiologist should be to ensure a complete, cost-effective work-up. This evaluation is best directed by the type of tinnitus, objective v subjective, and the presence or absence of a vascular retrotympanic mass. HRCT is the initial examination of choice in the majority of instances. Normal vascular variants can be confidently differentiated from paragangliomas with this study. While angiography continues to play an important role in the initial evaluation of a select group of these patients, the role of MR should be adjunctive.