Movement of the tympanic membrane causing pulsatile tinnitus

Background: Movement of the tympanic membrane can be a cause of pulsatile tinnitus. There are many etiologies that cause movement of the tympanic membrane, including otogenic pneumocephalus. This is an uncommon presentation after head injury that may be missed as the diagnosis of the primary cause of the symptoms.

Objective: To report a rare case of pulsatile tinnitus because of otogenic pneumocephalus.

Methods: Case report from chart review with relevant investigations and treatment.

Results: We describe the very interesting case of a patient who presented with pulsatile tinnitus because of otogenic pneumocephalus. On examination, we found a moving tympanic membrane. A CT scan revealed pneumocephalus in the right temporoparietal region that was continuous with the adjacent mastoid air cells. There was a transverse fracture through the mastoid process. A meticulous mastoidectomy with unroofing of the epitympanum was performed with widening of the aditus ad antrum. The mastoid cavity was closed without fat obliteration. After the operation, the pulsatile tinnitus ceased completely.

Conclusion: Mastoidectomy and unroofing the epitympanum without fat obliteration is a very simple and effective option for the treatment of pulsatile tinnitus because of pneumocephalus.