Pulsatile tinnitus is a rhythmic sound heard in the ears or head, often described as a whooshing, thumping, or humming that synchronizes with one’s heartbeat. This internal sound can vary in intensity and may be perceived in one or both ears. Its duration is not uniform and differs significantly, stemming from diverse underlying factors.
Understanding Pulsatile Tinnitus
Pulsatile tinnitus differs from other forms of tinnitus, which typically involve continuous ringing, buzzing, or hissing sounds not tied to the body’s rhythms. Its rhythmic nature directly relates to blood flow within vessels near the ear, often becoming more noticeable during physical activity or when the heart rate increases.
A healthcare professional can sometimes hear the sound using a stethoscope placed near the ear or neck, classifying it as “objective” pulsatile tinnitus. If only the individual can hear the sound, it is considered “subjective.” These sounds are essentially amplified perceptions of blood circulating through arteries and veins in the head and neck.
Causes and Duration
The duration of pulsatile tinnitus is directly linked to its underlying cause, ranging from temporary conditions to more persistent structural issues. Changes in blood flow near the ear, whether due to increased volume, rapid movement, or turbulence, are common factors. Conditions that increase overall blood flow, such as severe anemia or an overactive thyroid gland (hyperthyroidism), can lead to pulsatile tinnitus that may resolve once these systemic issues are addressed. Pregnancy can also cause temporary pulsatile tinnitus due to increased blood volume.
Vascular abnormalities are frequently associated with persistent pulsatile tinnitus. These include atherosclerosis, where hardening arteries create turbulent blood flow, or arteriovenous malformations (AVMs), which are abnormal tangles of blood vessels. Tumors in the head and neck, though often benign, can also develop abnormal blood vessels that produce this rhythmic sound. Additionally, elevated pressure around the brain, known as idiopathic intracranial hypertension (IIH), can cause pulsatile tinnitus by compressing blood vessels, often persisting until the pressure is lowered.
Diagnostic Process and Treatment
Identifying the specific cause of pulsatile tinnitus begins with a detailed medical history and a physical examination. During this examination, a doctor may listen with a stethoscope to the neck and skull to determine if the sound is objective.
Imaging tests are frequently used to pinpoint the underlying issue. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) evaluate vascular structures and soft tissues in the head and neck, while computed tomography (CT) scans provide detailed views of bone structures. Angiography may also be performed for a precise diagnosis of vascular anomalies. Once a cause is identified, treatment focuses on addressing that specific condition. For example, medication might be prescribed for high blood pressure or thyroid issues, while surgical intervention could be necessary for vascular malformations or tumors.
Prognosis and Persistence
The outlook for pulsatile tinnitus varies considerably, depending on whether the underlying cause can be successfully treated. If the cause is temporary or responds well to intervention, such as correcting anemia or managing hypertension, the pulsatile tinnitus may resolve completely.
However, if pulsatile tinnitus stems from chronic underlying conditions or is not fully treatable, the sound may persist long-term. Even then, management strategies can help improve quality of life. These may include sound generators to mask the sound or therapies like cognitive behavioral therapy to help individuals cope with the perception. Seek medical attention if rhythmic sounds in the ear suddenly appear, especially if accompanied by other symptoms like vision changes or balance issues, as this may indicate a more serious underlying condition.