The sensation of ear pulsing, often described as a rhythmic whooshing or throbbing sound, is medically known as pulsatile tinnitus. This symptom is distinct from other types of tinnitus because the sound is synchronized with the heartbeat, acting as an audible awareness of blood flow near the ear structures. While the sound is often benign, the underlying cause relates to changes in the body’s vascular system. Because it can signal a serious underlying medical condition, any experience of pulsatile tinnitus warrants a medical evaluation to identify and treat the source. Addressing the root cause is the only reliable method for stopping the ear pulsing sensation.
Defining the Symptom: Pulsatile vs. Non-Pulsatile Tinnitus
Pulsatile tinnitus is characterized by the perception of a rhythmic sound that beats in time with the patient’s pulse. Individuals can often confirm this synchronization by checking their pulse at the wrist or neck while listening to the sound. The sound is typically described as a rushing, thumping, or flowing noise, much like an internal soundtrack of one’s circulation.
This differs significantly from non-pulsatile, or somatic, tinnitus, which accounts for the majority of tinnitus cases. Non-pulsatile forms are usually perceived as a continuous ringing, buzzing, or hissing sound that does not follow a specific rhythm. Non-pulsatile tinnitus often stems from auditory pathway damage, such as from noise exposure or age-related hearing loss, and is almost always subjective, meaning only the patient can hear it.
Pulsatile tinnitus often has a physical source, arising from the body’s vascular system. The sound is generated when blood flow becomes turbulent rather than smooth as it passes through arteries or veins close to the middle or inner ear. This turbulent flow creates noise that is transmitted through the surrounding bone and tissue to the cochlea.
Pulsatile tinnitus can be subjective (heard only by the patient) or objective (meaning a clinician can also hear the sound using a stethoscope placed near the ear or neck). The presence of an objective sound confirms a physical disturbance in blood flow or structure near the auditory system. Identifying whether the sound is arterial or venous helps guide the diagnostic process toward the underlying vascular disturbance.
Common Underlying Vascular and Structural Causes
The ear pulsing sensation is linked to conditions that increase the volume or speed of blood flow, or cause anatomical changes that create turbulence near the ear. Vascular causes are the most common group, categorized into arterial, venous, and arteriovenous malformations. A common arterial cause is atherosclerosis, where plaque buildup narrows the arteries, forcing blood to flow more turbulently past the ear.
High blood pressure, or hypertension, can also contribute to the sound by increasing the force of blood against vessel walls, thereby amplifying the noise transmitted to the ear. Arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) involve irregular connections between arteries and veins, which cause high-pressure blood to flow rapidly into lower-pressure veins, creating a distinct, audible whooshing sound.
Venous causes frequently involve issues with the large veins that drain blood from the brain, such as the sigmoid and transverse sinuses. Idiopathic intracranial hypertension (IIH), a condition involving elevated fluid pressure around the brain, is a frequent venous cause, often associated with a narrowing of the venous sinuses. This narrowing, or stenosis, disrupts the smooth venous flow and creates noise that is conducted to the ear.
Structural causes can also lead to pulsatile tinnitus by amplifying normal body sounds. Rare, highly vascular tumors like glomus tumors, which grow in the middle ear or near the jugular bulb, create noise due to abnormal blood vessel networks. Additionally, conditions causing conductive hearing loss, such as a perforated eardrum or fluid in the middle ear, reduce the masking effect of external sound. This makes the patient acutely aware of their normal internal blood flow sounds.
Immediate Coping Mechanisms and Targeted Medical Treatment
While the search for the underlying cause is underway, immediate coping strategies can help manage the perception of the ear pulsing. Sound masking is an effective method that involves introducing low-level external noise to cover or distract from the internal sound. Using a white noise machine, a fan, or soft music creates a soothing auditory environment, making the rhythmic pulsing less noticeable, especially when trying to sleep.
Stress reduction techniques are also beneficial, as anxiety can intensify the awareness of internal symptoms. Practices such as deep breathing exercises, meditation, or yoga help lower stress levels and promote relaxation. This can reduce the distress caused by the pulsatile sound, helping the individual change their reaction to the sound rather than eliminate it entirely.
The goal for stopping pulsatile tinnitus is the targeted treatment of the underlying medical condition. The first step is a thorough medical evaluation by a specialist, often an otolaryngologist, including a physical examination and listening for the sound near the ear or neck. Diagnostic imaging is then employed to visualize the blood vessels and surrounding structures.
Depending on the suspected cause, imaging may include Computed Tomography Angiography (CTA) or Magnetic Resonance Angiography (MRA) to look for vascular abnormalities like stenosis, tumors, or malformations. Once the cause is confirmed, treatment is specific: for high blood pressure, medication and lifestyle changes are prescribed. Vascular malformations or tumors often require minimally invasive procedures like embolization or surgical intervention to correct the abnormal blood flow. Treating the specific cause, such as stenting a narrowed vein in cases of IIH, is the only way to reliably eliminate the ear pulsing sensation.