Dural arteriovenous fistula (DVAF) is a rare condition. However, it is important for not only otolaryngologists but also neurologists and neurosurgeons because it is the most common cause of pulsatile tinnitus and it can also be only clue to a potentially life-threatening disease such as intracranial vascular malformation. Diagnosis of dural arteriovenous fistula is usually delayed because it takes time to be enlarged enough to emerge radiologically. Pulsatile tinnitus with normal otoscopic examination and normal hearing threshold often presents a diagnostic challenge. Evaluation of patient with pulsatile tinnitus requires a detailed history, a comprehensive audiological evaluation with neuro-otological physical examination with imaging study. We report two patients with pulsatile tinnitus caused by an arteriovenous fistula of the transverse sigmoid sinus which was successfully treated with coil embolization and gamma kinfe.
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