Multiple Dural Arteriovenous Fistulas Presenting as Pulsatile Tinnitus

Tinnitus is the perception of sound in the absence of an external acoustic stimulus.1 When there is noise near the ear generated by underlying vascular or other disorders, it is referred to as “objective tinnitus.” Objective tinnitus, especially due to vascular causes, can be diagnosed and treated differently from other types of tinnitus.2 Therefore, it is important to suspect an objective origin of tinnitus for early detection and appropriate management. A dural arteriovenous fistula (DAVF) is a vascular cause of objective tinnitus. It is an abnormal shunt within the dura, between the arterial and venous system. The location of DAVF and its disruption of the blood flow can produce symptoms such as pulsatile tinnitus, bruit, headaches, visual changes, seizure, cranial nerve palsies, and motor or sensory deficits. We herein report the rare presentation of DAVF supplied by multiple arteries including the right ascending pharyngeal, posterior auricular, and middle meningeal arteries, and both occipital arteries.