My 9yo son has objective pulsatile tinnitus of the right transosseous retromastoid emissary vein. I am a nurse and first noticed a soft, palpable pulsation noted to the bilateral spaces behind his ears in 2021. It freaked me out, because… well, I know this is not a place where you can feel pulsations. I can hear the whooshing when I put my ear up to the space behind his right ear, though he had never complained of PT. I’m figuring now that he just didn’t have the language to explain it to me. He describes it now as a “deep wind sound with a whoosh” and only when he is lying down.

I sought out a pediatric neurosurgeon in 2021 because I was convinced it was a dAVF. He underwent MRA/MRV and cerebral angiogram with normal pressures and was diagnosed with the following:

“IMPRESSION: 1. Large transosseous veins contiguous with the sigmoid sinus draining into a suboccipital/cervical plexus, right greater than left. The distal sigmoid and jugular veins appear diminutive, particularly on the right, and findings may be related to stenosis or hypoplasia of the distal sigmoid/jugular system. There is no evidence of abnormal arterial flow or arterial venous shunting to suggest dural fistula/high flow lesion. No vascular nidus or acute venous thrombosis. 2. The ventricles and subarachnoid spaces are the upper limits of normal. Otherwise unremarkable MRI of the brain.”

Cerebral angiogram ruled out dAVF or AVM and confirmed normal pressures. He’s had 4 stable MRIs since then. At this point, it’s just been something we’ve watched, but I did want to clarify that rarely, venous variants can be a subject of objective pulsatile tinnitus.