Pulsatile Tinnitus: A Comprehensive Clinical Approach to Diagnosis and Management Pacheco-López, Sofía Martínez Barbero, José Pablo Busquier-Hernández, Heriberto García-Valdecasas Bernal, Juan Espinosa Sánchez, Juan Manuel Tinnitus Pulsatile tinnitus Clinical approach Arteriovenous fistula Idiopathic intracranial hypertension Pulsatile tinnitus (PT) is a subtype of tinnitus characterized by a perception of heartbeat-synchronous sound. It represents approximately 5–10% of all tinnitus cases and may have either a vascular or non-vascular etiology. Accurate diagnosis is crucial due to the potentially serious implications this condition can entail. Assessment through anamnesis and physical examination may often suggest a diagnosis of PT, but it is rarely definitive. Therefore, a comprehensive and specific imaging diagnostic protocol is essential when evaluating PT. A lack of consensus has been identified regarding the use of a standardized protocol for both pulsatile and non-pulsatile tinnitus, whether unilateral or bilateral. Consequently, neuroradiologists, otologists, and otoneurologists from a tertiary hospital have developed a new imaging diagnostic protocol for PT. The aim of this article is to present an updated approach to the diagnostic and therapeutic management of PT, aiming to establish a protocol that serves as a guide for clinicians assessing this symptom. In patients with bilateral PT, systemic conditions leading to increased cardiac output should generally be ruled out; in unilateral cases, focused imaging studies should be performed to exclude organic etiologies at the cervical and cranial levels. 2025-07-08T09:23:01Z 2025-07-08T09:23:01Z 2025-06-22 journal article Pacheco-López, S.; Martínez-Barbero, J.P.; Busquier-Hernández, H.; García-Valdecasas-Bernal, J.; Espinosa-Sánchez, J.M. Pulsatile Tinnitus: A Comprehensive Clinical Approach to Diagnosis and Management. J. Clin. Med. 2025, 14, 4428. [DOI: 10.3390/jcm14134428] https://hdl.handle.net/10481/105108 10.3390/jcm14134428 eng http://creativecommons.org/licenses/by/4.0/ open access Atribución 4.0 Internacional MDPI