Clinical Report: APT may fall short in pulsatile tinnitus
Overview
In a retrospective, single-center cohort of 107 adults with subjective pulsatile tinnitus, ambient pressure tympanometry (APT) showed limited accuracy for identifying radiologic correlates or surgeon-defined diagnoses. The authors concluded that imaging should still be pursued when an APT tracing is negative.
Background
Subjective pulsatile tinnitus can be associated with radiologic findings as well as diagnoses that are not identifiable through imaging. APT waveform patterns have been evaluated as a potential screening method for detecting sources of subjective pulsatile tinnitus. The study assessed APT against radiologic correlates and surgeon-defined diagnoses as separate reference standards. The American College of Radiology’s 2023 tinnitus criteria describe clinical evaluation, audiometry, and otoscopy before imaging, with vascular imaging commonly used when pulsatile tinnitus is present and no retrotympanic vascular lesion is seen.
Data Highlights
| Analysis | Reference standard | Sensitivity | Specificity | PPV | NPV |
|---|---|---|---|---|---|
| Full cohort | Radiologic correlate | 51% | 57% | 41% | 66% |
| Full cohort | Surgeon diagnosis | 43% | 55% | 43% | 55% |
| PT as primary complaint | Radiologic correlate | 57% | 54% | Not reported | Not reported |
| PT as primary complaint | Surgeon diagnosis | 44% | 54% | Not reported | Not reported |
| Study cohort | 107 adults; imaging performed in 137 ears | Radiologic correlate identified in 51 ears | |||
Key Findings
- Two audiologists independently reviewed APT tracings in a retrospective review of 107 adults with subjective pulsatile tinnitus who had complete audiometric testing.
- Among 137 imaged ears, 51 had a radiologic correlate; 26 of those ears had a pulse-synchronous APT waveform.
- Against radiologic findings in the full cohort, APT sensitivity was 51% and specificity was 57%; PPV was 41% and NPV was 66%.
- Against surgeon-defined diagnoses, APT sensitivity was 43% and specificity was 55%, with PPV and NPV both 43% and 55%, respectively.
- In the subgroup with pulsatile tinnitus as the primary complaint, APT performance was similar: sensitivity and specificity were 57% and 54% against radiologic correlates, and 44% and 54% against surgeon diagnoses.
- Of 86 ears without an identified radiologic correlate, 23 received a surgeon diagnosis; 17 were attributed to sources not identifiable through imaging, including middle ear myoclonus, patulous or obstructive Eustachian tube dysfunction, sensorineural hearing loss, and bruxism.
Clinical Implications
The study authors state that clinicians should pursue imaging regardless of a negative APT tracing. The ACR 2023 criteria advise clinical evaluation, audiometry, and otoscopy before imaging and describe CT angiography or MR-based angiography/venography as commonly used approaches for pulsatile tinnitus when no retrotympanic vascular lesion is seen.
Conclusion
APT had limited screening performance for radiologic correlates and surgeon-defined diagnoses in this cohort. The authors caution against using a negative APT tracing to determine that imaging is unnecessary.
Related Resources & Content
- Study authors, Otology & Neurotology Open, year not provided — Screening Utility of Ambient Pressure Tympanometry for the Detection of Radiologic Correlates of Subjective Pulsatile Tinnitus
- American College of Radiology, 2023 — ACR Appropriateness Criteria® Tinnitus: 2023 Update
- European Society of Head and Neck Radiology, year not specified in supplied reference — ESR Essentials: diagnostic strategies in tinnitus—practice recommendations by the European Society of Head and Neck Radiology
- BMC Neurology — The longer, the better? Investigating the effect of prolonged acoustic stimulation on brief acoustic tinnitus suppression
- Frontiers in Neurology — Efficacy differences and predictors of personalized mixed acoustic therapy in chronic tinnitus patients with and without hearing loss
- JAMA Otolaryngology — Mobile Application as a Digital Therapeutic for Chronic Tinnitus: A Randomized Clinical Trial
- Frontiers in Neurology — Clinical Trial Protocol for Evaluating Acupuncture's Effects on Chronic Tinnitus Using Auditory Brainstem Response Measurements
- ACR Appropriateness Criteria® Tinnitus: 2023 Update
- Screening Utility of Ambient Pressure Tympanometry for the Detection of Radiologic Correlates of Subjective Pulsatile Tinnitus
- Executive Summary of the Clinical Practice Guideline on Tinnitus Update - Adams - 2026 - Otolaryngology–Head and Neck Surgery - Wiley Online Library
- ACR Appropriateness Criteria® Tinnitus: 2023 Update - PubMed
- ESR Essentials: diagnostic strategies in tinnitus-practice recommendations by the European Society of Head and Neck Radiology.
- Systematic Review of the Diagnostic Imaging Evaluation of Pulsatile Tinnitus - PMC
- Screening Utility of Ambient Pressure Tympanometry for the Detection of Radiologic Correlates of Subjective Pulsatile Tinnitus.
Based on findings from:
APT may fall short in pulsatile tinnitus
Andrea Surnit. MDSpire News, 2026.
https://news.mdspire.com/otolaryngology/articles/apt-may-fall-short-in-pulsatile-tinnitus/
This content is an AI-generated, fully rewritten summary based on a published scholarly article. It does not reproduce the original text and is not a substitute for the original publication. Readers are encouraged to consult the source for full context, data, and methodology.
