Dural arteriovenous fistula presenting as subjective pulsatile tinnitus

Pulsatile tinnitus with normal otoscopic findings often presents a diagnostic challenge to the otolaryngologist. The underlying etiology of subjective pulsatile tinnitus is not always easily identifiable, and frequently it is not pursued clinically for lack of physical findings to substantiate further costly and potentially invasive evaluation. However, failure to establish a correct diagnosis may be catastrophic, since serious associated intracranial abnormality may be present. We describe a man who developed subjective pulsatile tinnitus in the right orbital region after a traffic accident. A dural arteriovenous fistula was diagnosed with magnetic resonance imaging/magnetic resonance angiography, confirmed by digital subtraction angiography, and then treated with the use of selective transarterial embolization.