On Tuesday evening, September 17, the Navigating the Medical System Lecture Series, hosted by Congregation Etz Chaim, opened its 14th season with a fascinating and important virtual lecture on treating Pulsatile Tinnitus.
Dr. Mel Breite, Founder and Director of Navigating the Medical System, welcomed everyone to the first lecture of the season.
Dr. Srikanith R. Boddu, Director of Neurointerventional Radiology at NewYork-Presbyterian Queens Hospital, shared an extremely informative lecture on causes and treatments of Pulsatile Tinnitus. He explained that this condition, which is a ringing in the ears, has two categories. The subjective type is heard by the patient, and the objective type is heard by the patient and seen by the physician with a definite underlying cause.
The patient describes this as a whooshing, ringing, roaring, chirping, or clicking sound, or a sound that goes with the heartbeat.
He shared that patients have an underlying problem with ear bone, or vascular problems, or the problem is unknown.
Two thirds of patients have an underlying vascular problem, which is what is causing this condition. It impacts day-to-day life. One third of patients say it’s annoying but they can deal with it. Two thirds of patients say it limits day-to-day life. They have trouble focusing, it causes social isolation, anxiety, depression, trouble sleeping, and trouble working. It impacts the quality of life negatively. It causes heavy financial loss. He estimated a loss of around $30,000 per person.
He then explained how he diagnoses the problem. First, he takes a complete medical history and a thorough physical exam is performed. Next, he provides a set of questions on quality of life. Level One and Level Two patients can continue with normal life. Level Three patients are on the border with differences each day, and Level Four and Level Five patients require treatment.
Examination with an otoscope is standard protocol, and then he does an MRI of the brain, an MRA (which looks at arteries of the brain), and an MRV (which looks at veins of the brain).
Dr. Boddu shared that the majority of the time the problem is a venous problem. He explained that arteries take fresh blood to the brain and veins bring blood back from the brain.
If the underlying cause is arterial, then the risk of stroke is high.
Venous pathology causes noise but is not life-threatening.
If an angiogram shows that the risk of bleeding is high, then it must be treated.
Dr. Boddu explained that the venous problem is caused by an abnormal connection. There would be high pressure in the artery and low pressure in the venous system. The high pressure empties into the venous system.
Venous pathology is not life-threatening.
The noise is caused by hearing the blood flow to the brain, since the ear is close to the brain.
An aberrant vascular loop, which is an abnormal blood vessel, can also cause tinnitus.
He explained that venous sinus stenosis happens in young patients of child-bearing age. The blood flows from right or left down the neck to the heart. A tight narrowing of the venous behind the ears is what causes this problem.
In the past, it was treated with surgery, but the patient lost hearing in that ear.
The current treatment is venous intervention through an arm or wrist. You no longer need open surgery. It’s done through an IV and it’s an outpatient procedure. It takes around 40 minutes. The patient experiences instant results and stops hearing the noise.
The ear bone is fine-tuned and delicate, and its found in the strongest bone in the body. He noted how G-d made it this way.
The bone can erode into the mastoid. To treat this, they use a stent and pack platinoid coils to take away the tinnitus.
Dr. Boddu has done this procedure over the past 14 years. Everyone had resolution except one patient who had diminished noise, but it was not completely resolved.
He shared the following take home message: Pulsatile Tinnitus is a very treatable condition and can receive immediate and permanent resolution. After brain surgery like this, the patient goes home with only a band aid on his arm. No hospital stays, no six-week recuperation. It’s truly remarkable.
Many physicians tell the patient that you have to live with it, or work around it, or it’s all in your head. He quipped that, yes, it’s all in your head and it can be treated.
In the Q & A following the lecture, he shared that he treats brain aneurysms and anything vascular in the brain or spine in this way. All is done outpatient. He also noted that compression fractures in the elderly can be treated with a needle that adds bone cement to the fracture.
He also shared that, after Covid, there was an uptick in the number of patients. The virus could have had a side effect of causing tinnitus.
Dr. Boddu shared his contact information: 718-303-3739 or This email address is being protected from spambots. You need JavaScript enabled to view it..
As always, the community thanks Dr. Breite for this informative and enlightening medical program.
by Susie Garber
