Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow, increased blood turbulence near the ear, such as from atherosclerosis or venous hum, but it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear. Rarely, pulsatile tinnitus may be a symptom of potentially life-threatening conditions such as carotid artery aneurysm or carotid artery dissection. Pulsatile tinnitus may also indicate vasculitis, or more specifically, giant cell arteritis. Pulsatile tinnitus may also be an indication of idiopathic intracranial hypertension. Pulsatile tinnitus can be a symptom of intracranial vascular abnormalities and should be evaluated for irregular noises of blood flow (bruits). Pathophysiology
It may be caused by increased neural activity in the auditory brainstem, where the brain processes sounds, causing some auditory nerve cells to become over-excited. The basis of this theory is that many with tinnitus also have hearing loss.Three reviews of 2016 emphasized the large range and possible combinations of pathologies involved in tinnitus, which in turn result in a great variety of symptoms demanding specifically adapted therapies. Diagnosis
The diagnostic approach is based on a history of the condition and an examination of the head, neck, and neurological system. Typically an audiogram is done, and occasionally medical imaging or electronystagmography.
Telmisartan/hydrochlorothiazide, sold under the brand name Micardis HCT among others, is a fixed-dose combination medication used to treat high blood pressure. It is a combination of telmisartan an angiotensin II receptor antagonist with hydrochlorothiazide a diuretic. It may be used if telmisartan by itself is not sufficient. It is taken by mouth.Common side effects include dizziness, upper respiratory tract infections, nausea, diarrhea, and tiredness. Severe side effects may include kidney problems, electrolyte problems, and allergic reactions. Use during pregnancy may harm the baby. Telmisartan works by blocking the effects of angiotensin II while hydrochlorothiazide works by decreasing the kidneys ability to retain water.The combination was approved for medical use in the United States in November 2000, and in the European Union in April 2002. The combination is on the World Health Organizations List of Essential Medicines. It is available as a generic medication. References
External links
"Hydrochlorothiazide mixture with telmisartan". Drug Information Portal. U.S. National Library of Medicine.