Abstract
Venous pulsatile tinnitus and tinnitus-like symptoms associated with internal jugular venous outflow disturbance represent an emerging clinical topic with specific diagnostic and management challenges. A narrative review was conducted using English-language literature identified through searches of PubMed, Web of Science, and Google Scholar. The review focused on studies published through February 2026 that addressed venous pulsatile tinnitus, internal jugular vein stenosis or compression, cerebral venous outflow disturbance, imaging and hemodynamic assessment, and management strategies. This review summarizes current evidence on vascular anatomy, clinical presentation, pathophysiological mechanisms, imaging evaluation, and treatment. Structural venous abnormalities and external compression may produce disturbed flow and local vascular sound, particularly in classical venous pulsatile tinnitus, whereas venous congestion, intracranial pressure dysregulation, altered cerebral perfusion, and central auditory plasticity remain proposed mechanisms for other tinnitus-like symptoms. MRI/MRV, CTV/CTA, and Doppler ultrasonography provide complementary anatomical and hemodynamic information. Invasive angiography is reserved for selected patients, with venous manometry added when pressure-gradient assessment is clinically relevant. Management options include conservative care, intracranial pressure management, endovascular treatment, surgical decompression, and supportive tinnitus therapy. However, current evidence is derived mainly from selected retrospective cohorts and small case series and does not establish the prevalence or causal contribution of IJVOD in unselected patients with venous pulsatile tinnitus. Standardized terminology, validated diagnostic criteria, improved patient selection, and prospective multicenter studies are required to enhance diagnostic confidence and enable robust assessment of long-term outcomes.