Tinnitus and Pediatric Pseudotumor Cerebri Syndrome

Pseudotumor cerebri syndrome (PTCS) is defined by increased pressure of cerebrospinal fluid (CSF), with normal CSF contents and without any intracranial disease found on brain imaging. PTCS is a disease with a predilection for childbearing obese women, but it may also occur in children and in man. The most common symptoms include headache, double vision, transient visual obscuration, and pulsatile tinnitus. The reason for which patients with increased CSF pressure experience tinnitus is not clear, and only a few studies have focused on the etiology of this peculiar clinical feature in the context of PTCS presentation. Besides tinnitus, additional otologic manifestations in children with PTCS include aural fullness, low-frequency hearing loss, and vertigo; these symptoms altogether can easily mimic Ménière disease. We hereby present two girls, who presented tinnitus as the first clinical symptom of PTCS, prior to developing headache and visual anomalies, and speculate on a shared pathophysiologic basis for both PTCS and Ménière disease.