# Pulsatile Tinnitus as a Manifestation of Radiation-Induced Internal Carotid Artery Stenosis in a Nasopharyngeal Carcinoma Survivor: A Case Report

## TL;DR

A long-term survivor of nasopharyngeal cancer developed pulsatile tinnitus and other symptoms due to a narrowed carotid artery, highlighting the need for early vascular checks in post-radiation patients.

## Contribution

Highlights carotid stenosis as a rare but important cause of pulsatile tinnitus in long-term NPC survivors.

## Key findings

- A patient with NPC developed carotid stenosis 18 years after radiotherapy, causing tinnitus and neurological symptoms.
- Carotid stenting resolved the patient's dizziness and tinnitus, confirming the vascular origin of the symptoms.
- The case emphasizes the need for early vascular assessment in post-radiation patients with atypical symptoms.

## Abstract

Nasopharyngeal carcinoma (NPC) is prevalent in East and Southeast Asia, with radiotherapy being the primary treatment modality. Carotid artery stenosis is a serious but often overlooked complication of radiotherapy. We present the case of a middle-aged NPC survivor who developed progressive symptoms, including left facial numbness, dysphagia, tongue atrophy, postural dizziness, and pulsatile tinnitus, 18 years after concurrent chemoradiation. Carotid ultrasound revealed high-grade stenosis of the left cervical internal carotid artery. Following carotid stenting, his dizziness and tinnitus resolved. This case illustrates the insidious progression of carotid stenosis after radiotherapy and underscores the importance of early vascular assessment in post-radiation patients with atypical symptoms such as pulsatile tinnitus. Clinicians should maintain a high index of suspicion in at-risk individuals, and physical therapists should adopt precautionary rehabilitation strategies to minimize the risk of vascular complications.