Vascular loops and pulsatile tinnitus: Culprit or innocent bystander? – An illustrative case and systematic literature review

Vascular loops are a common finding on imaging and their clinical significance depends on whether they cause compression of nearby structures. The association of vascular loops as a direct cause of otological symptoms such as pulsatile tinnitus (PT) is currently under debate. PT can be an incapacitating condition, so efforts to correctly identify and classify its cause must be made to provide an appropriate intervention and symptom relief. We present 5 illustrative cases of patients who came to our institution with complaints of PT, where imaging studies revealed a vascular loop. Furthermore, we performed a literature search using the MEDLINE, Scopus and Web of Science databases to look for cases of PT associated with vascular loops. Our review yielded a total of 52 studies, with only 4 articles (31 patients), specifying a clinical presentation of both PT and vascular loop in the same patient. Although there appears to be a connection between the presence of vascular loops and the manifestation of pulsatile tinnitus, current studies have not proved direct causality.