A 39-year-old woman reports left-sided tinnitus that beats in time with her pulse. Otoscopy shows a reddish pulsatile mass behind an intact left tympanic membrane. Auscultation over the mastoid reveals a bruit. Which statement is correct regarding her management?
- A This is objective pulsatile tinnitus, and imaging such as CT or MR angiography is required before any intervention because a vascular tumour is suspected ✓
- B Biopsy of the middle ear mass through the tympanic membrane is indicated to confirm the diagnosis
- C This is subjective tinnitus and should be managed with sound therapy and counselling
- D The findings are typical of Meniere disease and she should start betahistine and salt restriction
Correct answer: A. This is objective pulsatile tinnitus, and imaging such as CT or MR angiography is required before any intervention because a vascular tumour is suspected
Explanation
Tinnitus synchronous with the pulse and audible to the examiner is objective tinnitus. C pulsatile retrotympanic red mass with a mastoid bruit strongly suggests glomus tympanicum or glomus jugulare tumour. Imaging with CT or MR angiography defines tumour extent and feeding vessels before treatment, typically embolisation followed by surgery or radiotherapy. Biopsy through the drum risks torrential haemorrhage and is contraindicated, and Meniere disease causes fluctuating low-frequency hearing loss with vertigo, not a pulsatile mass.
Reference: Dhingra Diseases of Ear, Nose and Throat, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.