Pulsatile tinnitus is a perception of rhythmic sound, often described as a whooshing, throbbing, or humming, that is synchronized with one’s heartbeat. This article explores its nature, common underlying medical causes, and the relationship between stress and this condition.
Understanding Pulsatile Tinnitus
Pulsatile tinnitus presents as a rhythmic sound inside the ear, typically aligning with the individual’s pulse. This distinguishes it from other forms of tinnitus, which usually involve a constant ringing, buzzing, or hissing sound without a discernible rhythm. The sound, often described as a whooshing or thumping, can become more noticeable in quiet environments, particularly at night. Unlike generalized tinnitus, pulsatile tinnitus frequently has an identifiable physical source, making it a symptom rather than a condition itself.
Common Underlying Causes
Pulsatile tinnitus often arises from changes in blood flow within vessels located near or in the ear. Vascular issues are a frequent cause, including conditions like atherosclerosis, where plaque buildup narrows arteries and creates turbulent blood flow that can be heard. High blood pressure can also contribute by increasing the force of blood against vessel walls. Venous hums, which are benign conditions caused by abnormal blood flow in the jugular veins, can also lead to this rhythmic sound.
Other causes involve conditions affecting the head and neck. These include idiopathic intracranial hypertension, characterized by increased fluid pressure around the brain, which can narrow veins and produce a whooshing sound. Certain tumors, such as glomus tumors in the middle ear, are highly vascular and can create audible blood flow. Arteriovenous malformations or fistulas, abnormal connections between arteries and veins, also result in turbulent blood flow. Anemia and hyperthyroidism can also increase blood flow, potentially leading to pulsatile tinnitus.
The Impact of Stress
Stress is generally not considered a direct cause of pulsatile tinnitus, which typically has a physical origin related to blood flow or anatomical structures. Instead, stress can significantly influence how a person perceives and experiences existing pulsatile tinnitus. Anxiety, a common companion to stress, heightens awareness of internal bodily sensations, including the sound of one’s own heartbeat. This increased sensitivity can make the rhythmic sounds of pulsatile tinnitus seem louder or more intrusive.
The physiological responses to stress, such as an elevated heart rate and increased blood pressure, can also intensify the perception of pulsatile tinnitus. Muscle tension, often associated with stress, might indirectly affect structures around the ear, potentially contributing to the audibility of these internal sounds. Experiencing persistent pulsatile tinnitus can itself be a source of stress and anxiety, creating a cycle where the symptom amplifies distress, and distress amplifies the symptom.
Diagnosis and Management
Seeking a medical evaluation is an important first step if you experience pulsatile tinnitus, as it often indicates an underlying medical condition. A healthcare provider will typically begin with a detailed medical history and a physical examination of the head and neck. To identify the specific cause, various diagnostic imaging techniques may be employed. These can include computed tomography (CT) scans, magnetic resonance imaging (MRI), and angiography (CTA or MRA) to visualize blood vessels and detect any abnormalities or tumors. Blood tests may also be conducted to check for conditions like anemia or thyroid issues.
Management of pulsatile tinnitus primarily focuses on treating the identified underlying cause. For instance, if high blood pressure is the cause, medication and lifestyle changes may be recommended. If a vascular anomaly or tumor is detected, specific medical or surgical interventions might be necessary to address the issue. When no specific cause is found, or if symptoms persist after treatment, strategies such as sound therapy using white noise generators or cognitive behavioral therapy can help manage the perception and impact of the sound.