The sensation of hearing a rhythmic whooshing or thumping sound in your ear is a symptom known as pulsatile tinnitus. This experience is distinct from common forms of tinnitus, which typically involve a continuous ringing, buzzing, or hissing sound. The pulsing noise is a physical sound generated by the body and amplified by the ear, meaning it often has an identifiable underlying cause requiring medical evaluation.
Identifying Pulsatile Tinnitus
Pulsatile tinnitus is characterized by a rhythmic sound—often described as throbbing, whooshing, or rushing—that is consistently synchronized with the listener’s pulse. This phenomenon results from turbulent blood flow in the major arteries and veins near the ear structures.
Unlike non-pulsatile tinnitus, which is subjective, pulsatile tinnitus is frequently considered objective; a clinician can sometimes hear the sound with a stethoscope placed near the ear or neck. The sound may become louder during physical exertion or when lying down due to changes in blood pressure or flow dynamics. Recognizing this pulse-synchronous rhythm helps distinguish it from other ear noises and points toward a physical source.
Common Underlying Causes of the Sound
Pulsatile tinnitus occurs when altered blood flow near the ear causes turbulence. Causes are broadly categorized into vascular issues, conditions that increase blood flow, and mechanical or structural problems. Vascular causes include atherosclerosis, where the narrowing of arteries near the head and neck creates uneven, audible blood flow. Conditions like fibromuscular dysplasia or venous sinus stenosis (a narrowing in the veins draining the brain) can also disrupt smooth flow.
Conditions that increase the volume or speed of blood flow, known as high cardiac output states, can also trigger the pulsing sound. These include anemia, where the heart works harder to deliver oxygen, and hyperthyroidism, which increases metabolic rate and heart speed. High blood pressure (hypertension) puts increased force against vessel walls, making the sound of blood movement more apparent near the auditory system.
Mechanical or structural issues can amplify internal body sounds. This includes conductive hearing loss, which reduces the perception of outside noise, making internal sounds more prominent. Rarer causes involve highly vascular tumors (like glomus tumors) or idiopathic intracranial hypertension, which involves elevated fluid pressure around the brain. Because the causes are diverse, only a medical professional can accurately determine the specific source of the sound.
Immediate Relief and Home Management Techniques
While awaiting a professional diagnosis, several home management techniques can reduce the distress caused by the pulsing sound. Noise masking is an effective strategy, involving the introduction of low-level ambient sound to cover the internal noise. Using a white noise machine, a fan, or a sound app, especially at night, can make the rhythmic thumping less noticeable.
Stress and anxiety can heighten the perception of the pulsing, making the symptom feel louder. Employing stress-reduction techniques, such as deep breathing exercises or meditation, helps manage the emotional reaction to the sound. These practices do not eliminate the physical cause but help the brain filter the internal noise.
Adjusting head position can sometimes provide temporary relief, as the sound often changes with posture, particularly when the cause is venous. Some individuals find the sound lessens when they gently compress the jugular vein on the affected side of the neck, which may indicate a venous issue. Positional changes during sleep, such as slightly elevating the head, may also reduce the noise intensity.
Medical Diagnosis and Professional Treatment Options
A comprehensive medical evaluation is necessary for pulsatile tinnitus, as identifying the underlying cause is the basis for treatment. Diagnosis typically begins with a thorough physical exam, including a blood pressure check and auscultation of the neck and head to listen for objective sounds called bruits. Blood tests may also be ordered to screen for systemic conditions like anemia or thyroid disorders.
Imaging studies are often required to visualize the vascular structures near the ear and brain. These tests may include a CT scan with angiography (CTA) or an MRI with magnetic resonance angiography (MRA) to look for narrowed arteries, venous anomalies, or vascular malformations. A Doppler ultrasound of the neck may also be used to assess blood flow through the carotid arteries.
Treatment is always directed at resolving the diagnosed cause, which can lead to the elimination of the tinnitus. If high blood pressure is the cause, medication and lifestyle adjustments are used to normalize pressure and smooth blood flow. For structural issues like venous sinus stenosis, minimally invasive procedures such as venous stenting may be used to widen the vessel. Seeking prompt medical attention is important if the pulsing sound is accompanied by symptoms like dizziness, headaches, or changes in vision, as these can signal serious underlying conditions.