Clinical evaluation of pulsatile tinnitus: history and physical examination techniques to predict vascular etiology.
| Autor: | Cummins, Daniel D., Caton, M. Travis, Hemphill, Kafi, Lamboy, Allison, Tu-Chan, Adelyn, Meisel, Karl, Narsinh, Kazim H., Amans, Matthew R. |
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| Předmět: |
MEDICAL history taking
PHYSICAL diagnosis RESEARCH funding RECEIVER operating characteristic curves LOGISTIC regression analysis SURGICAL anastomosis DIGITAL subtraction angiography MULTIVARIATE analysis DESCRIPTIVE statistics TINNITUS ARTERIOVENOUS fistula COMPRESSION therapy CEREBROVASCULAR disease CONFIDENCE intervals HEARING disorders SENSITIVITY & specificity (Statistics) HEALTH care teams DISEASE complications |
| Zdroj: | Journal of NeuroInterventional Surgery; May2024, Vol. 16 Issue 5, p515-521, 6p |
| Abstrakt: | Background Pulsatile tinnitus (PT) may be due to a spectrum of cerebrovascular etiologies, ranging from benign venous turbulence to life threatening dural arteriovenous fistulas. A focused clinical history and physical examination provide clues to the ultimate diagnosis; however, the predictive accuracy of these features in determining PT etiology remains uncertain. Methods Patients with clinical PT evaluation and DSA were included. The final etiology of PT after DSA was categorized as shunting, venous, arterial, or non-vascular. Clinical variables were compared between etiologies using multivariate logistic regression, and performance at predicting PT etiology was determined by area under the receiver operating curve (AUROC). Results 164 patients were included. On multivariate analysis, patient reported high pitch PT (relative risk (RR) 33.81; 95% CI 3.81 to 882.80) compared with exclusively low pitch PT and presence of a bruit on physical examination (9.95; 2.04 to 62.08; P=0.007) were associated with shunting PT. Hearing loss was associated with a lower risk of shunting PT (0.16; 0.03 to 0.79; P=0.029). Alleviation of PT with ipsilateral lateral neck pressure was associated with a higher risk of venous PT (5.24; 1.62 to 21.01; P=0.010). An AUROC of 0.882 was achieved for predicting the presence or absence of a shunt and 0.751 for venous PT. Conclusion In patients with PT, clinical history and physical examination can achieve high performance at detecting a shunting lesion. Potentially treatable venous etiologies may also be suggested by relief with neck compression. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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