Pulsatile tinnitus Q&A w/ Mayo Clinic expert, Dr. Breen July 16

Dr. Breen - I had COVID Sept 5th 2024 that began with headache and severe neck pain - and that's when my tinnitus and pulsatile tinnitus began. I've had MRI's but not a CT scan. I've had dental recommendations, and wearing a dental appliance at night. My neck pain and stiffness has not greatly improved so I did see an orthopedic physician who prescribed PT to focus on the SCM muscle as he felt it was viral nerve damage, I recently saw another ENT (have seen 3) and he said he believed it was glossopharyngeal nerve neuralgia and has prescribed low dose gabapentin - the pulsatile tinnitus comes and goes and the tinnitus can be severe but also can come and go - I can have a good day with little tinnitus, and then a bad day with severe tinnitus - I realize not easy to diagnose based on a comment - but based on any previous post COVID cases, can you make any recommendations based on what I've been doing to this point? I appreciate your opinion.

@caroland75, thank you – at Mayo Clinic, there’s an appointment request process. If you would like to request an appointment, you can speak with an appointment coordinator using the contact information on this link: https://careinfo.mayoclinic.org/ear-hearing-balance-fl

It's very hard to give you a specific answer without seeing all your records and scans. When it is neck-related, it makes me think about PT caused by blood flowing through veins. It's tough to push hard enough on your neck to collapse the carotid artery - but the veins are easily compressed. My first test of choice for a patient with that specific symptom is often a CT scan of the temporal bones (the ear), potentially with contrast. Also, some patients find that treatments like cognitive behavioral therapy (CBT) help them manage symptoms that modern medicine or surgery can't completely fix - this could be something to investigate. Wishing you the best on your treatment journey!

Hi everyone, as we wrap up this week’s Q&A session, I just wanted to extend my thanks for your participation. We did our best to answer as many questions as possible without commenting on individual patient needs due to the lack of necessary patient records and imaging. Thank you for your understanding. Wishing you all the best in your PT journey!

Several forms of tinnitus seem to change with jaw movements or jaw/neck muscle manipulation for many patients. Based on this description, my first choice of a diagnostic test would typically be a CT scan of the temporal bones, with contrast. This could help to provide a clearer understanding of the underlying cause.

I am 85 and diagnosed with Patulous eustachian tubes. I have tried 2 different nose drops. Voice is louder and anxiety is painful. I want to apply to Mayo Clinic for help. Is this a possibility?

Dear Dr. Breen, thank you very much for advice, which I find very helpful.
BR, robert

I have Patulous eustachian tubes. I need to know if Mayo clinic will use hyaluronic acid to plump eustachian tubes opening. I'm 85 and the anxiety has ruined my life. I lost weight due to atrophic gastritis. I have no sense of smell nor taste. So I'm having trouble gaining weight. I am praying that a doctor will have interest in helping. There is currently no good treatment for this condition and seems to be no concern .

I had very loud sounds of late evening tree frogs or Katydids chirping. A friend decided to get RIFE equipment. Probably 3 times maybe 4 she ran the computer program while I was visiting and my tinnitus of several years went away. Now I have Patulous eustachian tubes from losing weight due to stomach . Some times pressure of voice and ears and stress will build and cause it for a few hours but nothing like what it had been. Find someone and do the RIFEing. It will not hurt you and may help.

I’m so sorry to hear you have PET also. It seems to be a very rare affliction. I’m 77 and have dealt with it for 20 years after a cerebellar stroke. None of the ENT specialists I saw here in New Zealand had heard of it, so I did my own homework. Took time! Eventually I found something that has helped me significantly. I believe it is readily available in USA as well. Neilmed sinus rinse. It took me quite some time to work out a process but it works for me. Hopefully it may help you too. All I do is take one strong sniff in to nostril, tilt my head to one side until I can feel a small pop. A bit like a clearance. Bring head back to centre and ‘snort’ the rinse out into hand basin. I then repeat the same procedure on the other side. I think the trick is to hold the saline solution as long as you can before releasing it. I seriously give it a very ‘forced snort’ out, otherwise it doesn’t work for me.
Of course it’s impossible to do this while you’re out anywhere but I’ve also discovered by slowly drinking a cup of hot water as I sit in the car (can’t socialise) quietly focusing on relaxing my body this method works well for me.
When one is desperate they will try anything. I sincerely hope this is helpful for you.