The experience of hearing sound when no external source is present is known as tinnitus, a symptom affecting millions of people. A distinct form, pulsatile tinnitus (PT), involves a rhythmic sound that pulses in sync with the individual’s own heart beat, often described as a whooshing, thumping, or heartbeat sound. Given that stress can elevate heart rate and blood pressure, it is a common concern whether stress alone causes this rhythmic noise. However, unlike the more common, constant ringing or buzzing of non-pulsatile tinnitus, PT frequently signals an underlying physical or vascular issue that requires medical attention.
What is Pulsatile Tinnitus?
Pulsatile tinnitus (PT) is characterized by a sound synchronous with the heartbeat, meaning the perceived rhythm matches the individual’s pulse. This sensation is typically a whooshing, throbbing, or rhythmic pulsing, which can be confirmed by checking the pulse against the sound. The noise originates from the ear’s proximity to major blood vessels in the head and neck.
When blood flow is turbulent or altered in these vessels, the resulting vibrations are picked up by the ear structures. Unlike non-pulsatile tinnitus, which is usually a steady ringing or buzzing, PT is most often linked to circulatory or vascular conditions. PT is considered a symptom that is more likely to have a single, identifiable physical cause.
How Stress Affects Tinnitus Perception
Stress is rarely the primary cause of pulsatile tinnitus, but it acts as a powerful amplifier that can worsen the perception of the sound. The physiological response to stress involves releasing hormones like cortisol and adrenaline, which directly impact the cardiovascular system. This hormonal surge elevates heart rate and blood pressure, increasing the volume and force of blood flow through vessels near the ear.
The increased speed and pressure of blood moving through these vessels make pre-existing vascular sounds louder and more noticeable. Stress also commonly leads to increased muscle tension, particularly in the jaw and neck areas. This tension can affect blood flow patterns or interfere with sound conduction, potentially contributing to the intensity of the pulsatile sounds.
Anxiety and stress focus attention inward, leading to a heightened awareness of internal bodily sensations. This hyper-awareness can make a sound that might otherwise be filtered out become a prominent and distressing symptom. The presence of the rhythmic noise then causes additional anxiety, creating a cycle where stress intensifies the symptom, and the symptom generates more stress.
Underlying Medical Causes of Pulsatile Tinnitus
Pulsatile tinnitus frequently signals a physical change within the vasculature or nearby structures and requires medical investigation. The causes are broadly categorized into vascular, systemic, and structural issues that alter blood flow near the ear.
Vascular and Structural Causes
Turbulent blood flow, which creates the audible sound, is often caused by issues affecting arteries and veins.
- Arterial Narrowing: Conditions like atherosclerosis cause blood vessels near the ear to lose elasticity, leading to turbulent flow.
- Structural Malformations: Abnormal connections between arteries and veins, such as dural arteriovenous fistulas (dAVFs) or arteriovenous malformations (AVMs), result in turbulent flow.
- Tumors: Highly vascular tumors, like glomus tumors, can also press on blood vessels, causing the pulsatile sound.
Venous Causes
Venous issues account for a significant portion of PT cases, often involving major veins in the brain. One common venous cause is Idiopathic Intracranial Hypertension (IIH), a condition characterized by high pressure in the fluid around the brain. IIH causes PT by compressing large venous sinuses within the skull, such as the transverse and sigmoid sinuses, disrupting blood flow.
Systemic Causes
Systemic conditions that increase the speed or volume of blood flow can also cause PT. These include high blood pressure (hypertension), severe anemia, or an overactive thyroid (hyperthyroidism). In these instances, the underlying condition is the true source of the sound, with stress only making the symptom more apparent.
When to Consult a Specialist
Prompt medical evaluation is necessary because pulsatile tinnitus often signals an underlying physical condition. Evaluation typically begins with a primary care physician or an otolaryngologist (ENT). The doctor performs a physical exam, including listening to the neck and skull with a stethoscope to determine if the noise is objective.
The diagnostic process involves audiologic tests and advanced imaging to visualize blood vessels and surrounding structures. Imaging procedures, such as Magnetic Resonance Angiography (MRA) or Computed Tomography Angiography (CTA), are used to assess blood flow and identify vascular abnormalities. These tests help pinpoint the source of the turbulent blood flow, such as a narrowed artery, venous compression, or a vascular malformation. A neuro-otologist or neuro-radiologist may be consulted for specialized interpretation.