The challenge of diagnosing intracranial pressure elevations as an otolaryngologist

What is it about?

Many patients seen in otolaryngology clinics complain of chronic headaches, dizziness, pulsatile tinnitus, ear fullness, imbalance, or vestibular migraine-like symptoms, yet routine neurologic and otologic evaluations are often unrevealing.

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Photo by Vitaly Gariev on Unsplash

Photo by Vitaly Gariev on Unsplash

Why is it important?

In this review, we discuss the challenge of recognizing mild or intermittent intracranial pressure elevation in ENT practice. These patients frequently do not meet classic criteria for idiopathic intracranial hypertension because papilledema may be absent and lumbar puncture opening pressures may fluctuate. The article highlights clinical patterns that should raise suspicion for abnormal intracranial pressure physiology, including pulsatile tinnitus, pressure-sensitive headaches, positional worsening, dizziness, obesity, empty sella, transverse sinus abnormalities, and associated venous outflow disturbances. We also review how modern imaging and venous studies are reshaping the understanding of vestibular migraine-like syndromes and chronic headache disorders. The goal is to encourage otolaryngologists to recognize these patients earlier and collaborate with neurology, neuroradiology, and neurosurgery colleagues when appropriate.

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