Clinical characteristics of patients showing tympanic membrane pulsation

Visible tympanic membrane (TM) pulsation is an uncommon otoendoscopic finding that may reflect middle ear or intracranial pathology.
To characterize clinical features and etiologies of TM pulsation in an outpatient otology setting.
We retrospectively reviewed 34 consecutive adults (mean age 56 ± 13 years) with TM pulsation identified on routine otoendoscopy (January 2022–September 2024). All patients underwent audiologic testing and temporal bone computed tomography; internal auditory canal magnetic resonance imaging was performed when indicated. Patients with neurological symptoms or suspected intracranial hypertension were excluded.
Middle ear effusion was the most common cause (61.8%), frequently associated with pulsatile tinnitus. Healed TM perforation accounted for 26.5% of cases. Less common etiologies included jugular diverticulum, arachnoid granulation with tegmen dehiscence, temporal encephalocele, and postoperative TM graft pulsation. Imaging findings supported correlations between TM movement and underlying middle ear or adjacent structural abnormalities.
In outpatient populations, visible TM pulsation predominantly reflects middle ear cavity conditions rather than intracranial pressure changes. Awareness of this sign may facilitate early detection of clinically relevant lesions, including encephalocele and vascular anomalies, and guide timely imaging and management.