The sensation of hearing a rhythmic whooshing or thumping sound in your ear, often synchronized with your pulse, is known as pulsatile tinnitus. Unlike common tinnitus, which involves a constant ringing or buzzing, this variant is a perception of a sound that has a physical source within the body. Understanding its underlying origins is the first step toward finding relief, which involves self-management techniques and professional medical options.
Understanding the Source of the Sound
This internal sound is caused by changes in blood flow or an increased awareness of normal blood flow in vessels near the ear structure. Smooth blood flow is generally silent, but any alteration creates turbulence that the ear perceives as noise. This turbulence is the physiological mechanism behind most cases of pulsatile tinnitus, which are broadly categorized into vascular and non-vascular issues.
Vascular causes involve abnormalities in the arteries and veins that carry blood to and from the head and neck. Conditions like atherosclerosis, where arteries become narrowed and hardened, force blood to flow unevenly, making a louder sound as it passes close to the inner ear. Similarly, high blood pressure can increase the force of the blood against vessel walls, amplifying the audible pulsing.
Structural anomalies in the head’s blood vessel network, such as arteriovenous malformations or dural arteriovenous fistulas, can create abnormal connections between arteries and veins. These malformations cause blood to move at high speed and pressure, resulting in a distinct, audible rush that aligns with the heartbeat. Venous sinus stenosis, a narrowing in the veins that drain blood from the brain, can also alter flow dynamics and generate the characteristic pulsing sound.
Non-vascular causes can make the sound of blood flow more noticeable, even if the flow itself is normal. Conductive hearing loss is a common example, occurring when sound transmission to the inner ear is impaired by factors like fluid buildup or a perforated eardrum. This loss of external sound effectively makes internal body sounds, including nearby circulation, seem much louder.
Another non-vascular mechanism involves the muscles of the middle ear or the soft palate at the back of the throat. Rhythmical contractions of these muscles, known as myoclonus, can create a repetitive clicking or thumping sound. Conditions that increase overall blood flow throughout the body, such as severe anemia or an overactive thyroid gland (hyperthyroidism), can also result in a generalized increase in the sound of circulation near the ear.
Immediate Steps for Temporary Relief
Several practical techniques can help manage the sensation temporarily. Sound masking involves introducing a low-level, non-intrusive external sound to obscure the internal pulsing. Devices like white noise machines, fans, or dedicated sound therapy apps generate ambient noise that makes the rhythmic thumping less prominent, particularly in quiet environments.
Lifestyle modifications can reduce the intensity of the symptom, as the sound often intensifies with increased heart rate or blood flow. Avoiding stimulants such as caffeine and nicotine, which speed up the heart, may lessen the perceived volume of the pulsing. Managing stress through techniques like mindfulness meditation or deep breathing promotes relaxation and a corresponding drop in heart rate and blood pressure.
For individuals who find the sound highly distressing, psychological coping methods are often beneficial. Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) are therapeutic approaches that teach patients how to change their reaction to the sound rather than attempting to eliminate the sound itself. These methods focus on reducing the emotional impact and anxiety associated with the symptom.
Identifying When to Consult a Healthcare Professional
Because pulsatile tinnitus can be the first sign of a serious underlying medical condition, professional evaluation is advisable. Consult a healthcare provider if the rhythmic sound is persistent, occurs only in one ear, or is getting progressively worse over several weeks or months. A medical professional can perform a physical examination and determine the need for specialized testing.
Certain accompanying symptoms are considered red flags that require more immediate attention. These include the sudden onset of the pulsing sound, especially if associated with neurological issues like changes in vision, dizziness, or a sudden loss of sensation or weakness. If the sound is accompanied by pain, vertigo, or a noticeable change in hearing, a prompt medical assessment is warranted to rule out conditions such as vascular abnormalities or tumors.
Individuals with a history of cardiovascular disease, high blood pressure, or other vascular issues should seek an evaluation. This ensures the symptom is not a sign of a complication. Identifying and treating the underlying cause is the definitive way to resolve the sound.
Medical Interventions to Resolve the Cause
Resolving pulsatile tinnitus depends on accurately diagnosing the underlying cause, which often involves specialized imaging studies. Diagnostic tests commonly begin with a thorough audiologic evaluation and may proceed to non-invasive imaging like Magnetic Resonance Angiography (MRA) or Computed Tomography Angiography (CTA). These tests create detailed pictures of the blood vessels and soft tissues to pinpoint structural issues, such as narrowed arteries or vascular malformations.
In some situations, a more detailed view is required, and a catheter-based angiography may be performed, which remains the most precise method for imaging blood flow abnormalities. For a condition like idiopathic intracranial hypertension, which involves elevated fluid pressure around the brain, diagnosis may involve an ophthalmology exam to check for swelling of the optic nerve (papilledema) and a lumbar puncture to measure the fluid pressure.
Once the cause is identified, treatment is targeted specifically at that condition. If the sound is linked to high blood pressure or atherosclerosis, the intervention typically involves medication to manage blood pressure and reduce cholesterol, which can normalize blood flow and quiet the sound. Endovascular procedures, such as placing a stent to open a narrowed venous sinus, are sometimes used to treat specific vascular issues that are causing the symptom.
For structural anomalies like tumors or certain types of vascular malformations, surgical or minimally-invasive interventional procedures may be necessary to correct the issue. In cases where the cause is a transient issue like anemia or an overactive thyroid, treating the underlying medical disorder with medication resolves the pulsatile sound.