Screening Utility of Ambient Pressure Tympanometry for the Detection of Radiologic Correlates of Subjective Pulsatile Tinnitus.

OBJECTIVE

To determine the sensitivity and specificity of ambient pressure tympanometry (APT) for the detection of a radiologic correlate of subjective pulsatile tinnitus (PT).

STUDY

DESIGN

Retrospective review.

SETTING

Tertiary care clinic.

PATIENTS: 107 adults (147 ears) with PT who underwent APT between 2021 and 2025.

INTERVENTIONS: Blinded audiologists classified APT tracings as pulse-synchronous or not.

MAIN OUTCOME MEASURES: Sensitivity and specificity of APT using any radiologic diagnosis or surgeon-defined diagnosis as 2 separate gold standards.

RESULTS

Of 137 (93.2%) ears that underwent imaging, 63 (46%) had a pulse-synchronous APT pattern. Fifty-one (37.2%) had a radiologic correlate, and 65 (44.2%) were given a surgeon diagnosis. Respectively, APT sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 51%, 57%, 41.3%, and 66.2% for a radiologic correlate and were 43.1%, 54.9%, 43.1%, and 54.9% for a surgeon diagnosis. In a subgroup of 86 patients (116 ears) with a chief complaint of PT, APT sensitivity, specificity, PPV, and NPV for a radiologic correlate were 56.9%, 54.2%, 46%, and 55.2%, and for a surgeon diagnosis were 43.6%, 54.1%, 46.2%, and 51.6%.

CONCLUSION

With a low sensitivity and specificity, APT may not be a reliable screening tool for the detection of a radiologic correlate of subjective PT. Clinicians should continue to pursue radiologic evaluation of PT despite a negative APT and counsel patients on the limits of imaging and the potential need for multiple modalities for the detection of subjective PT sources.