Objective pulsatile tinnitus on a vascular basis is a relatively uncommon auditory phenomenon. There are other forms of objective tinnitus which will not be covered in this discussion. The most common lesions are arteriovenous malformations near the temporal bone which are branches of the external carotid artery, such as the occipital artery, to the transverse or sigmoid sinus. Diagnostically, a patient can be entirely asymptomatic except for a pulse-synchronous objective tinnitus in one ear. There is usually no associated hearing loss, vertigo, imbalance or pressure. A sense of fullness may not be a constant problem but may be intermittent. The objective pulsatile tinnitus may not be a constant problem but may come and go for no apparent reason.

Ploidy status of squamous cell carcinomas of the head and neck (SCCHN) from primary and recurrent tonsillar and tongue lesions has not been compared using image cytometry. We have measured and compared the DNA indices in 41 cases. There were 29 tongue SCCHN, 20/29 were primary and 9/29 were recurrent. Mean DNA index (DI) was 1.19 (range 0.70–1.81) and 1.28 (range 0.79–1.94) respectively. There were 12 tonsillar cases, 10/12 primary and two out of 12 recurrent. Mean DI was 0.84 (range 0.57–1.09) and 1.00 (range 0.98–1.02) respectively. Mean DNA indices of both primary carcinomas were lower than the mean DNA indices of the recurrent carcinomas. This difference between the two groups may be a reflection of their tumour biology. However, since our study is small no definite conclusions can be made at this stage. We aim in the future to evaluate the prognostic role of DNA indices of patients with paired primary and recurrent SCCHN. This may be of clinical value and improve the treatment modalities available to this group.