What’s New Versus Tried and True in Pulsatile Tinnitus

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June 2026

Is it Time to Give GLP-1s a Shot for Pulsatile Tinnitus and Related Conditions?

New data suggest that treating the many otologic manifestations of intracranial hypertension (IIH) and obesity, including pulsatile tinnitus (PT), hearing loss, and cerebrospinal fluid (CSF) leak, with glucagon-like peptide-1 (GLP-1) receptor agonists may be the next big thing in managing these complex, interrelated disorders.

Obesity is a key therapeutic target in this syndrome for two primary reasons, noted Adam S. Vesole, MD, a neurotology fellow at the University of Pennsylvania, department of otorhinolaryngology—head and neck surgery, in Philadelphia.

First, it is an extremely common shared comorbid condition in these patients: Upwards of 90% of IIH patients, for example, are obese (J Neuroophthalmol. doi:10.1097/WNO.0000000000000448). Second, obesity plays a major role in the development of elevated intracranial pressure (ICP), “which is the primary feature of IIH and its related otologic manifestations,” Dr. Vesole said.

One proposed mechanism linking obesity to elevated ICP is increased abdominal mass, which raises thoracic pressure and impairs intracranial venous return (J Neuroophthalmol. doi:10.1097/WNO.0000000000000448). This sustained pressure likely contributes to IIH and related otologic sequelae, Dr. Vesole noted.  However, common treatments for these sequelae—such as CSF leak repair and sigmoid sinus resurfacing for PT—“don’t really address ICP, which arguably is the root cause of these conditions,” he said. As a result, “after surgery, patients may be prone to failing their sinus dehiscence repair or having another CSF leak at a different site on their skull base.”

Some practitioners are aware of these dynamics and will prescribe acetazolamide (commonly known by its brand name, Diamox) to reduce ICP in their IIH patients. But Dr. Vesole and a team of co-investigators are looking to GLP-1 receptor agonists as an alternative.

“We’ve just started a prospective study, where we are recruiting obese patients either with or without IIH who meet criteria for GLP-1 therapy for weight loss,” Dr. Vesole said. “Then we will refer them to our metabolic or bariatric medicine colleagues to initiate and manage the GLP-1 treatment.”

The next step for his team will be to have patients take the Tinnitus Handicap Inventory (THI), a 25-question self-report survey that quantifies the impact of tinnitus on a person’s daily life. “We’ll then track these measures over time—our goal is at least six months, but hopefully up to a year—and see whether there is a significant difference in their THI, mental health, and overall quality of life.”

The prospective GLP-1 PT study is not Dr. Vesole’s first foray into this area of research. He is the first author on a 2025 paper that analyzed population-level data to assess the impact of GLP-1s on the incidence of CSF leak and surgical repair in IIH patients with obesity (J Neurol Surg B Skull Base. doi:10.1055/a-2678-8331). The investigators found that IIH patients on GLP-1 agonists (n = 11,825) were 24% less likely to develop a spontaneous cranial CSF leak (OR, 0.76; 95% CI, 0.61–0.94) and 72% less likely to undergo skull base CSF leak repair (OR, 0.28; 95% CI, 0.15–0.51) when compared with a non-GLP-1 group (n = 11,825).

Dr. Vesole acknowledged that GLP-1s have some downsides, including their well-documented GI side effects. Additionally, the medications delay gastric emptying, which increases the risk for aspiration if patients undergo anesthesia within one week of use. That can be a problem, he noted, in patients who need rapid, repeat otologic surgeries due to post-operative sequelae.

Still, “we need to start thinking of GLP-1s as effective adjuvant therapy for patients with these interrelated otologic syndromes,” Dr. Vesole said. “Do we need more long-term data? Of course. But the results with GLP-1s so far in some of these patients are very promising.”