A pulsing sensation in the ear, often described as a rhythmic thumping or whooshing sound, is known as pulsatile tinnitus. This phenomenon frequently aligns with one’s own heartbeat. Understanding its nature and potential origins can provide clarity and guide appropriate action.
Understanding Pulsatile Tinnitus
Pulsatile tinnitus is a type of tinnitus characterized by a rhythmic sound, such as a thumping or whooshing, that often synchronizes with your heartbeat. This distinguishes it from other forms of tinnitus, which typically involve a continuous ringing, buzzing, or hissing sound.
This sensation can occur in one or both ears. Unlike other types of tinnitus, which are subjective and only heard by the individual, pulsatile tinnitus can sometimes be heard by a medical professional using a stethoscope. This is because it frequently stems from a physical source, such as changes in blood flow near the ear.
Common Explanations for Pulsing in the Ear
A pulsing sound in the ear does not always indicate a serious condition. Temporary changes in blood flow are a common, less concerning reason for pulsatile tinnitus. After strenuous exercise, during heightened stress, or due to caffeine consumption, increased blood flow near the ear can become more noticeable.
The pulsing sound might also stem from benign ear conditions. Earwax buildup can obstruct the ear canal, altering sound transmission. Fluid accumulation in the middle ear, such as from an infection or allergies, can amplify the sound of blood flow. These explanations are often temporary and resolve once the underlying factor is addressed.
When It Signals a Serious Condition
While many causes of pulsatile tinnitus are benign, it can sometimes indicate a more serious medical condition, especially when related to changes in blood flow.
Vascular Conditions
Atherosclerosis, where arteries harden due to plaque buildup, can narrow blood vessels, causing turbulent blood flow that becomes audible. Carotid artery stenosis, a narrowing of the large arteries in the neck that supply blood to the brain, is another vascular issue leading to pulsatile tinnitus. High blood pressure (hypertension) can also contribute by increasing the force of blood against vessel walls, making flow more discernible.
Tumors
Certain tumors, such as glomus tumors, are highly vascular and can develop in the middle ear or near the jugular bulb. These tumors can press on nearby blood vessels or contain numerous blood channels, making the sound of blood flow audible.
Intracranial Pressure and Malformations
Conditions that increase intracranial pressure, such as idiopathic intracranial hypertension (IIH), can also cause pulsatile tinnitus. In IIH, an excess of cerebrospinal fluid around the brain puts pressure on blood vessels, leading to turbulent blood flow, often in the venous sinuses. Arteriovenous malformations (AVMs), abnormal tangles of blood vessels, can create unusual blood flow patterns that produce a distinct pulsing sound. These conditions warrant medical attention.
Symptoms Warranting Medical Consultation
Certain accompanying symptoms or characteristics should prompt a medical consultation for pulsatile tinnitus.
Seek professional evaluation if the pulsing:
Appears suddenly.
Is experienced in only one ear.
Occurs with dizziness, hearing loss, or vision changes.
Accompanies severe headaches.
Is persistent, does not resolve, or interferes with daily activities like sleep or concentration.
These signs suggest a potential underlying condition requiring diagnosis and treatment.
Medical Evaluation and Treatment Approaches
When evaluating pulsatile tinnitus, a healthcare provider begins with a detailed medical history and physical examination of the head and neck. This initial step helps identify causes and guide further diagnostic steps. The examination may involve listening with a stethoscope near the ear or neck to hear the pulsing sound, which can sometimes be objective.
Diagnostic Tests
To pinpoint the cause, various diagnostic tests may be employed. Imaging studies are commonly used, including:
Computed Tomography Angiography (CTA) of the head and neck, for detecting vascular lesions or increased intracranial pressure.
Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA), for soft tissue masses or to evaluate blood vessels.
CT venogram or ultrasound of the carotid arteries, to assess venous or arterial flow.
Treatment Approaches
Treatment for pulsatile tinnitus depends on its identified cause.
High Blood Pressure: Medication and lifestyle changes.
Vascular Issues: Minimally invasive procedures like endovascular stenting to improve blood flow.
Tumors: Surgical removal, radiation therapy, or observation, depending on type and location.
Benign Causes: If benign and untreatable, strategies like sound therapy may reduce its impact.