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Pulsatile tinnitus is a sound from within the body, mostly of vascular origin, that stimulates the patient's hearing in the same way as an external sound does, generally at the same pace as the pulse. Although not frequent, the diagnosis of its cause is crucial because of its potential severity in some cases. This article describes some of the diagnostic clues for arterial causes (arteriosclerosis, aberrant carotid artery, arteriovenous fistula or malformations, increased vascularization in Paget's disease) and venous causes (benign intracranial hypertension, high jugular bulb). In some cases we have to rule out other systemic diseases as hypertension, cardiac arrhythmia or hyperthyroidism. A pathological otoscopy result may be secondary to a tympanic glomus. A guided medical history and an algorithm for complementary tests (magnetic resonance or angio-resonance imaging, computerized tomography, blood test, Doppler ultrasonography) may resolve the diagnostic puzzle of pulsatile tinnitus. We present our experience in 80 cases. The most frequent aetiology has been the arteriosclerosis of the carotid artery (17.5 %) and the benign intracranial hypertension syndrome (10 %).
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It is known that the angiotensin receptor blockers (ARBs) have organ protective effects in patients with heart failure or renal impairment. Several studies have revealed that the ARB telmisartan has an organ protective effect, but there have been few studies directly comparing the effects of telmisartan and calcium antagonists, since most clinical studies on telmisartan have been conducted in treated patients or patients on combination therapy. The present study was conducted to compare the renal and vascular protective effects of telmisartan monotherapy and calcium antagonist monotherapy in untreated hypertensive patients. Forty-three patients with untreated essential hypertension were randomized to receive amlodipine (n=22) or telmisartan (n=21), which were respectively administered at doses of 5 mg and 40 mg once daily in the morning for 24 weeks. The patients were examined before and after treatment to assess changes of renal function, flow-mediated dilation (a parameter of vascular endothelial function), and brachial-ankle pulse wave velocity (baPWV; a parameter of arteriosclerosis). Before treatment, there were no significant differences in these parameters between groups. The decreases of urinary albumin excretion and baPWV, and the increase of flow-mediated dilation were significantly greater in the telmisartan group than the amlodipine group, while the antihypertensive effects were not significantly different between the two groups. In conclusion, these results suggest that telmisartan is more effective at protecting renal function and vascular endothelial function, and at improving arteriosclerosis than the calcium channel blocker in patients with essential hypertension.
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Mammary intra-arterial calcification (MIAC) as a predictor of occult diabetes has been suggested in the medical literature. However, the incidence of arteriosclerosis and atherosclerosis increases with age, as well as with hypertension and diabetes. The mammograms of 169 known diabetic women were reviewed for MIAC. Of the 27 (16%) women who had MIAC, 85% were aged 60 or older. There is no support for a direct relationship between MIAC and diabetes mellitus; MIAC is part of the aging process, where the population is at a greater risk for hypertension and/or diabetes.
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The efficacy of and tolerance to ticlopidine, a platelet inhibitor, in preventing progression of obliterative arterial disease was compared with that of a placebo in a double-blind and randomized trial in 43 patients (22 on placebo, 21 on ticlopidine) over a period of one year. The course of the disease in both groups was assessed by serial angiography of the lower limbs, both at the beginning and at the end of the study. There was a significantly reduced progression in the ticlopidine group (P less than 0.01). The results support the hypothesis that platelets are of great importance in the progression of arteriosclerosis and that inhibition of platelet function is an effective principle of prevention. Ticlopidine in this respect is an alternative to the use of acetylsalicylic acid.
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