Simple Things Are Not Simple: Pulsatile Tinnitus due to Tortuous Occipital Artery.

Background: Pulsatile tinnitus is often a chronic and debilitating condition and normally has a vascular origin. We describe a case of pulsatile tinnitus due to an aberrant branch of the external carotid artery (ECA), which has not been reported previously.

Method: A 67-year-old female with chronic unilateral pulsatile tinnitus, which could be controlled completely with direct pressure on a small tortuous superficial branch behind her left ear. This was confirmed with doppler to be an unusually tortuous occipital branch of the ECA. Under local anesthesia, this vessel was identified with intraoperative doppler and ligated.

Result: Complete resolution of tinnitus immediately, with consistent results 3 months postoperatively.

Conclusions: Pulsatile tinnitus due to aberrances in the occipital ECA branch is rare, and in this case, was successfully treated with minor surgery.