Anemia can cause pulsatile tinnitus, a rhythmic noise—often described as a whooshing, thumping, or heartbeat sound—that synchronizes with the pulse. Anemia is characterized by a lack of healthy red blood cells or insufficient hemoglobin, the protein responsible for carrying oxygen throughout the body. This deficiency in oxygen-carrying capacity triggers physiological adjustments that can ultimately lead to the audible perception of blood flow near the ear. Addressing the underlying anemia often leads to the resolution of this specific type of tinnitus.
The Physiological Link Between Anemia and Tinnitus
The primary mechanism linking anemia to pulsatile tinnitus involves changes in blood flow characteristics, specifically the development of turbulent flow. Anemia lowers the blood’s viscosity because it contains fewer red blood cells, making the blood thinner. The body interprets the reduced oxygen delivery as requiring more vigorous circulation to compensate.
To address this, the heart increases its rate and force of contraction, leading to an elevated cardiac output and a hyperdynamic circulatory state. This combination of thinner blood moving faster promotes the creation of turbulent blood flow, rather than the smooth, laminar flow found in healthy individuals. This change is particularly noticeable in large vessels like the carotid artery and jugular vein, which are situated close to the inner ear structures.
The sound heard is the direct amplification of this turbulent, high-volume blood movement. The ear perceives the increased arterial pulse pressure as the rhythmic, pulsing sound.
Recognizing Anemia Symptoms and Diagnosis
Pulsatile tinnitus caused by anemia is usually accompanied by other systemic symptoms that point toward an underlying blood disorder.
Common signs of anemia include:
- Persistent fatigue and generalized weakness.
- Pale skin tone.
- Shortness of breath.
- Dizziness.
- Cold hands or feet.
The diagnostic process begins with a physical examination and a review of the patient’s medical history. To confirm anemia, a physician orders a Complete Blood Count (CBC), which measures red blood cells and hemoglobin levels. If anemia is detected, further testing is required to determine the specific type, such as checking ferritin and iron levels to confirm iron-deficiency anemia. Before confirming anemia as the sole cause, the physician must rule out other serious causes, including vascular issues or tumors that could also cause audible blood flow disturbances near the ear.
Treating the Underlying Anemia to Resolve Tinnitus
The treatment for pulsatile tinnitus linked to anemia centers entirely on correcting the underlying blood deficiency. The goal is to restore the blood’s normal composition and viscosity and normalize the heart’s workload. The specific treatment protocol depends on the cause of the anemia.
For the most common type, iron-deficiency anemia, treatment involves oral iron supplementation to increase iron and hemoglobin levels. If the deficiency is due to Vitamin B12 or folate, supplements or injections of those vitamins are prescribed. Correcting the deficiency allows the body to produce sufficient healthy red blood cells, which increases blood viscosity and reduces the heart’s need to pump excessively.
This restoration of normal, laminar blood flow eliminates the turbulence perceived as a pulsing sound. Resolution of the tinnitus is not immediate, as it takes time for the blood counts to normalize. While some patients may notice an improvement within a few weeks, it may take several weeks to months of consistent treatment for the pulsatile tinnitus to fully disappear.