A Case of Pulsatile Tinnitus from the Atherosclerosis and Atheroma in Superior Labial Artery and Facial Artery
A 46 year old male patient experienced vibratory tinnitus on the right side for 10 years. He had pulsatile mass on the right side of his lip and did not undergo any treatment. Since 1 month before diagnosis, the level of tinnitus increased along with the size of the mass. Past medical history shows both lower limbs amputation 20 years ago and hypertension. Upon physical examination, there were no symptoms of tenderness, but 2 pulsatile masses were found on the right upper and right lateral side lip. The size of the former mass was 1×1 cm and the latter was 1.5×1.0 cm (). There were no other special abnormalities in the oral cavity, oropharynx and the other head and neck area. The tinnitus decreased when pressure was applied to the left tympanic membrane area and increased when leaning forward. The tympanic membrane was in sound condition and hearing tests revealed both ears to be normal. Similar observations were made during two times of tinnitogram. The frequency was 2 kHz, and loudness was between 60 and 70 decibels and there were no residual inhibitions. Arteriovenous malformation from the right facial artery was found resulting from computed tomography of the facial bone (). CT with angiography was not conducted due to hypotension and tachycardia after the injection of the contrast media. It was diagnosed as resulting from an abnormality in vessel and excisional biopsy was conducted through oral access after general anesthesia (). Operation revealed the superior labial artery and facial artery after incising the oral mucosa in the mass and the area showing evidence of vascular malformation was ligated. The area was irrigated and operation was concluded. Patient was allowed to return home 3 days after the operation. Pathology diagnosed the condition as atherosclerosis (). The patient did not complain of any tinnitus symptoms after the operation and shows no sign of recurrence up until now, 1 year after the operation.