Pulsatile tinnitus is a distinct type of tinnitus where individuals perceive a rhythmic whooshing, throbbing, or humming sound in one or both ears, often synchronized with their heartbeat. Unlike other forms of tinnitus, this internal sound can sometimes be heard by a doctor using a stethoscope, indicating a physical source.
Understanding Pulsatile Tinnitus
Pulsatile tinnitus is characterized by its rhythmic nature, distinguishing it from non-pulsatile tinnitus, which involves a continuous ringing or buzzing. Pulsatile tinnitus directly reflects blood flow within or near the ear, often described as hearing one’s own pulse, rushing water, or a throbbing. This rhythmic sound arises from changes in blood flow within vessels in the neck, at the skull’s base, or within the ear, making normal circulation sounds more noticeable. Because it often has an identifiable physical source, pulsatile tinnitus can be a symptom of an underlying medical condition, making its investigation important.
How Ear Infections Can Cause Pulsatile Tinnitus
Ear infections, such as acute otitis media (middle ear infection) or serous otitis media (glue ear), can lead to pulsatile tinnitus. An infection in the middle ear triggers inflammation and swelling, which can make blood flow sounds more pronounced. Fluid buildup (effusion) in the middle ear is another mechanism; this fluid increases pressure and alters sound transmission, amplifying internal body sounds. Additionally, ear infections can cause Eustachian tube dysfunction. Blockage of this tube leads to pressure changes that further amplify internal sounds, making the pulsatile sensation more apparent. This type of pulsatile tinnitus is often temporary and resolves once the ear infection is treated and the inflammation and fluid subside.
Other Causes of Pulsatile Tinnitus
Pulsatile tinnitus can stem from various other underlying conditions.
Vascular Issues
Vascular issues are a common category, including aneurysms (bulges in blood vessel walls) or arteriovenous malformations (AVMs), which are abnormal connections between arteries and veins. Carotid artery disease (narrowing of neck arteries) and a “venous hum” (abnormal blood flow in jugular veins) can also cause this sound. High blood pressure (hypertension) and atherosclerosis (hardening of arteries due to plaque buildup) can also cause turbulent, louder blood flow near the ear.
Tumors and Intracranial Pressure
Head and neck tumors, such as glomus tumors, can press on blood vessels, creating audible sounds. Increased intracranial pressure, as seen in idiopathic intracranial hypertension (pseudotumor cerebri), can also contribute by affecting blood vessels and cerebrospinal fluid.
Systemic Conditions and Hearing Loss
Other systemic conditions like severe anemia or an overactive thyroid gland (hyperthyroidism) can increase blood flow velocity, making circulation sounds more noticeable. Additionally, any condition causing conductive hearing loss, such as a perforated eardrum or otosclerosis, can make internal body sounds more audible.
Seeking Medical Attention and Treatment
Any new pulsatile tinnitus warrants a medical evaluation to determine its underlying cause. This is important if the sound is persistent, occurs in only one ear, or is accompanied by dizziness, hearing loss, ear pain, or headaches.
A doctor will perform a physical examination of the head, neck, and ears, and may conduct hearing tests. To identify the cause, imaging studies like MRI, MRA, CT scans, or venography are often used. Blood tests may also check for conditions like anemia or thyroid problems.
Treatment depends on the identified cause. If an ear infection is the culprit, treating it with antibiotics usually resolves the tinnitus. For other causes, interventions range from managing high blood pressure with medication, to surgical correction for vascular abnormalities or tumors, or medication to reduce intracranial pressure. Pulsatile tinnitus often resolves or improves once the underlying condition is diagnosed and addressed.