Persistence of pulsatile tinnitus in patients with idiopathic intracranial hypertension following resolution of papilledema

Background: Papilledema is commonly used as part of the diagnostic criteria for and to monitor progression and treatment of Idiopathic Intracranial Hypertension (IIH). Treatment is aimed at reducing intracranial pressure, and papilledema is typically seen to resolve with sufficient reduction of intracranial pressure. However, associated symptoms of intracranial hypertension may persist, adversely impacting quality of life. Our aim was to quantify the persistence of pulsatile tinnitus in IIH patients after resolution of their papilledema. Methods: We conducted a retrospective chart review of patients seen in our tertiary academic neuro-ophthalmology clinic for management of IIH between September 2019 and October 2023. Results: 246 consecutive patients with IIH were identified, 132 cases in whom papilledema had been documented to be present and were later documented to have resolved. 73 % (97/132) presented with pulsatile tinnitus. Of the patients with pulsatile tinnitus, 61 (59/97) were documented to have ongoing symptoms of pulsatile tinnitus even after resolution of papilledema. There were no significant differences in age, BMI, papilledema grade, or presence of transverse sinus stenosis at presentation between those with persistent tinnitus and those with resolved symptoms. Conclusions: Pulsatile tinnitus persists in a large portion of IIH patients even after resolution of papilledema. Further research is needed to characterize the underlying mechanisms and its impact on quality of life.