Pulsatile tinnitus is a disconcerting experience, often described as a “whooshing,” “thumping,” or “pulsing” sound synchronized with one’s heartbeat. Understanding this phenomenon is the first step toward addressing it.
Understanding the Sensation
Pulsatile tinnitus is a rhythmic noise heard in the head or ears that synchronizes with the listener’s heartbeat. It differs from other forms of tinnitus, which involve a constant ringing, buzzing, or hissing sound not tied to the pulse. People experiencing pulsatile tinnitus can often confirm its rhythmic nature by checking their own pulse while listening to the sound. This synchronization indicates that the sound originates from changes in blood flow within vessels near the ear or the ear’s heightened perception of that flow.
The sensation results from the ear becoming aware of blood circulating through nearby blood vessels, including those in the neck, at the base of the skull, and within the ear itself. When blood flows quickly or turbulently, it can produce audible noise. Unlike other types of tinnitus that stem from auditory nerve issues, pulsatile tinnitus often has a physical source related to the circulatory system.
Common Underlying Causes
Pulsatile tinnitus frequently arises from conditions affecting blood flow or the ear’s ability to perceive it. Vascular issues are a common cause. High blood pressure, for instance, can lead to increased pressure of blood against vessel walls, potentially causing pulsatile tinnitus. Atherosclerosis, which involves the hardening and narrowing of arteries due to plaque buildup, can create turbulent and louder blood flow that becomes audible. Abnormal connections between arteries and veins, known as arteriovenous malformations (AVMs), can also lead to turbulent blood flow.
Ear-related factors also contribute. Conditions causing conductive hearing loss, such as excessive earwax buildup or a perforated eardrum, can make a person more aware of internal body sounds. Tumors in the head and neck, though often benign, can develop abnormal blood vessels or press on existing ones, resulting in pulsatile tinnitus.
Certain systemic conditions can increase overall blood flow or sensitivity. Anemia and an overactive thyroid gland (hyperthyroidism) can cause blood to flow more quickly and loudly throughout the body, including near the ears. Idiopathic intracranial hypertension, a condition involving elevated cerebrospinal fluid pressure around the brain, can also lead to pulsatile tinnitus along with other symptoms like headaches.
Immediate Relief Strategies
Several non-medical strategies can offer immediate, temporary relief from pulsatile tinnitus. Minimizing exposure to loud external noises can help, as quiet environments often make the internal pulsing sound more noticeable. Using background noise, such as a fan, soft music, or a white noise machine, can mask the sound and make it less intrusive. Many smartphone applications offer sound libraries that can serve as masking agents.
Lifestyle adjustments can also play a role in managing the sensation. Reducing stress and anxiety through techniques like deep breathing, meditation, or mindfulness can be beneficial, as stress often exacerbates tinnitus symptoms. Maintaining a healthy diet and regular physical activity can improve circulation and overall well-being, potentially lessening the impact of pulsatile tinnitus. Limiting stimulants like caffeine, nicotine, and alcohol is often recommended, as these can affect blood flow and make the sound more pronounced for some individuals.
When to Seek Medical Attention
It is advisable to seek professional medical attention if you experience new or persistent pulsatile tinnitus. Certain symptoms or circumstances warrant prompt evaluation by a healthcare provider. If the pulsatile tinnitus is new, constant, or worsens over several weeks or months, it is important to consult a doctor. Hearing the sound in only one ear is another sign that medical assessment is needed, as it can sometimes indicate a more localized issue.
Additional symptoms accompanying pulsatile tinnitus should also prompt a medical visit. These include dizziness, changes in vision such as blurriness or double vision, headaches, hearing loss, or any new weakness or loss of sensation. Since pulsatile tinnitus can occasionally be a symptom of an underlying medical condition, getting a professional evaluation helps rule out any serious causes.
Professional Diagnosis and Treatment Options
Upon seeking medical attention for pulsatile tinnitus, a healthcare provider will typically begin with a thorough medical history and a physical examination, including an assessment of the head, neck, and ears. They may also check for signs of increased pressure in the brain by examining the eyes. Audiology tests, including pure tone and speech audiometry, are often performed to assess hearing and may use tympanometry to measure pulsing in the ears.
Imaging studies are frequently used to identify the underlying cause. These can include CT scans, CT angiography (CTA) of the head and neck, MRI, magnetic resonance angiography (MRA), or magnetic resonance venography (MRV) to visualize blood vessels and structures in the head and neck. Blood tests may also be conducted to check for conditions like anemia or thyroid problems.
Treatment for pulsatile tinnitus depends on the identified cause. If high blood pressure is the cause, medication to manage blood pressure may be prescribed. Earwax removal can resolve the issue if it stems from a blockage.
In cases of specific vascular abnormalities, interventions like stenting to widen narrowed veins or surgical repair may be considered. Tumors might require surgical removal or radiation therapy. If a specific cause is not found, management strategies may focus on symptom relief through sound generators or counseling.