Pulsatile tinnitus (PT) is the perception of a rhythmic sound in the ears, often described as a whooshing or throbbing synchronized with the individual’s heartbeat. This distinct pattern naturally leads people to question its connection to systemic health conditions, particularly hypertension, or high blood pressure (HBP). Because the sound is tied to blood flow, it suggests a vascular origin that can be influenced by changes in circulatory force. This article clarifies the relationship between elevated blood pressure and this specific auditory symptom.
What Exactly Is Pulsatile Tinnitus
Pulsatile tinnitus is often described as hearing one’s own pulse or heart beating in the ear. The sound is typically a low-pitched whooshing, rushing, or thumping noise that follows the rhythm of the heart. This differentiates it from the far more common type of tinnitus, which is usually perceived as a constant, high-pitched ringing or buzzing sound not synchronized with the pulse. PT is often a form of “objective” tinnitus, meaning the sound may be audible to a healthcare provider using a specialized stethoscope. This audibility confirms the noise has a physical source: the sound of blood flowing through nearby vessels.
The sound originates from turbulence or changes in blood flow within the arteries and veins near the ear structures, including the large carotid artery and jugular vein. Therefore, PT is less a condition itself and more a symptom indicating an underlying vascular or structural issue that makes the sound of blood flow noticeable.
Examining the Link Between High Blood Pressure and Tinnitus
Research has established an association between high blood pressure and tinnitus, especially the pulsatile form, but hypertension is rarely the sole cause. The increased force of blood pushing against vessel walls in people with HBP contributes to more turbulent and louder blood flow. If a person already has a structural irregularity in a blood vessel near the ear, the heightened force from hypertension can intensify the noise.
HBP can also contribute to the hardening and narrowing of arteries, a process known as atherosclerosis. When plaques build up in the carotid arteries, blood is forced to rush through a restricted opening, creating a louder, more turbulent sound perceived as pulsatile tinnitus. Treating uncontrolled hypertension may reduce the volume of the pulsing sound by decreasing the overall force and turbulence of the blood flow. However, the underlying structural issue that makes the sound audible will still remain unless addressed.
Studies show that a substantial percentage of people with tinnitus also have hypertension, suggesting an exacerbating relationship between the two conditions. While high blood pressure can amplify or worsen the symptom, it is typically a secondary contributor that makes an existing vascular sound more apparent.
When High Blood Pressure Is Not the Cause
When systemic hypertension is not the primary driver, pulsatile tinnitus is often caused by localized structural or flow-related anomalies. A common cause is a narrowing of the venous drainage system in the brain, such as venous sinus stenosis, which disrupts smooth blood flow in the large veins. Other venous abnormalities, like a sigmoid sinus diverticulum, can also create a whooshing sound transmitted to the ear.
Conditions that increase the total volume or speed of blood flow throughout the body can also lead to pulsatile tinnitus. For instance, severe anemia or an overactive thyroid (hyperthyroidism) increase cardiac output, causing blood to pulse faster and louder through the vessels. In these cases, the sound is a consequence of the generalized increase in circulatory dynamics.
Another significant cause involves increased pressure around the brain, known as Idiopathic Intracranial Hypertension (IIH). This condition involves elevated fluid pressure inside the skull, which can compress veins and lead to turbulent flow, often causing pulsatile tinnitus and sometimes vision changes. Furthermore, a physical malformation, such as an Arteriovenous Malformation (AVM) or a highly vascular tumor near the ear, can generate the audible pulse. Conductive hearing loss can also make normal internal body sounds, including blood flow, more noticeable because external sounds are muffled.
Taking Action and Seeking Diagnosis
Any persistent pulsatile tinnitus warrants a medical evaluation to identify the specific underlying cause. A healthcare provider will often begin by performing a physical examination, which includes listening with a stethoscope to the neck and skull to determine if the tinnitus is objective. They will also take a thorough medical history and check for associated symptoms like headaches or vision changes.
Diagnostic steps usually involve a blood pressure check and blood tests to screen for systemic causes like anemia or hyperthyroidism. Because many causes are structural, imaging studies are frequently ordered, such as a CT Angiography (CTA) or Magnetic Resonance Angiography (MRA). These specialized scans allow doctors to visualize the blood vessels in the head and neck, helping to pinpoint the source of the turbulent flow. Identifying the precise origin is necessary because successful treatment depends entirely on addressing the specific condition causing the noise.