Tinnitus is the medical term for perceiving sound when no external source is present, typically described as a ringing, buzzing, or hissing. Pulsatile tinnitus is a specific, less common form where the sound is rhythmic. People hear a whooshing, throbbing, or pulsing noise synchronized with their heartbeat. Unlike general tinnitus, which often relates to nerve damage, pulsatile tinnitus usually signals an underlying physical issue related to blood flow or vascular structures.
Is There a Direct Connection to COVID-19?
Clinical observations and emerging studies suggest a direct link between SARS-CoV-2 infection and the development of new or worsened tinnitus. While the majority of reported cases describe the more common non-pulsatile ringing, a confirmed statistical correlation exists between COVID-19 and the onset of auditory symptoms. Tinnitus has been reported to occur in a significant percentage of people following infection, with prevalence estimates varying widely in some studies focusing on long COVID.
Pulsatile tinnitus, specifically, appears to be a less frequent but documented symptom in those recovering from the virus. Case reports and patient data collection have noted the sudden onset of the pulse-synchronous sound during the acute phase of infection or as a persistent symptom of long COVID. This temporal correspondence suggests the viral illness or its lingering effects can trigger the condition. One systematic review noted that while non-pulsatile tinnitus was common, only a small number of cases specifically reported the pulsatile type, highlighting its relative rarity as a post-COVID symptom.
Potential Biological Causes
The mechanism by which the SARS-CoV-2 virus could induce a vascular symptom like pulsatile tinnitus is rooted in its wide-ranging effects on the body’s systems. The virus is known to trigger a profound systemic inflammatory response, often characterized by the excessive release of immune signaling molecules known as cytokines. This state of heightened inflammation can compromise the delicate tissues of the inner ear and auditory nerve pathways.
A more direct pathway to pulsatile tinnitus involves the virus’s effect on the vascular system. SARS-CoV-2 has a documented ability to cause endothelial dysfunction, which is damage to the inner lining of blood vessels. This damage can lead to turbulent blood flow in the arteries and veins near the ear structures, which is then perceived as the characteristic whooshing sound. The infection also increases the risk of thrombosis and the formation of microscopic blood clots (microclots) throughout the body.
If these microclots or vascular changes affect the small cochlear-vestibular artery, which supplies blood to the inner ear, they can cause localized ischemia, or restricted blood flow. This disruption of flow can contribute both to hearing alterations and to the perception of the turbulent vascular noise. Furthermore, the widespread inflammation and vascular compromise can sometimes lead to dysregulation of blood pressure. Changes in systemic blood pressure or localized blood flow velocity near the temporal bone and neck vessels would increase the volume of the blood flow sound, making it audible to the patient.
Prompt Medical Evaluation and Underlying Causes
Anyone experiencing a rhythmic sound in their ear that beats in time with their heart should seek prompt medical evaluation, ideally from an Ear, Nose, and Throat (ENT) specialist or a neurologist. Unlike non-pulsatile tinnitus, which is often a symptom of hearing loss, the pulsatile form is frequently a sign of an identifiable physical condition that requires a specific diagnosis. Seeking medical guidance ensures that any potentially serious, non-COVID-related underlying causes are quickly identified and addressed.
The medical workup is designed to differentiate COVID-related symptoms from other, independent conditions that cause turbulent blood flow near the auditory system. Common underlying causes that must be ruled out include vascular abnormalities, such as carotid artery stenosis or aneurysms, which can create audible turbulence. Conditions that increase the volume or speed of blood flow throughout the body, like severe anemia or an overactive thyroid gland (hyperthyroidism), are also common culprits.
Evaluation typically involves a thorough physical exam, often including listening to the neck and skull with a stethoscope to determine if the sound is “objective,” meaning the doctor can also hear it. Diagnostic imaging is a cornerstone of the evaluation, frequently involving computed tomography (CT) or magnetic resonance (MR) angiography and venography. These specialized scans are used to visualize the blood vessels in the head and neck, check for structural issues, and assess for conditions that increase pressure within the skull, such as idiopathic intracranial hypertension.