Pulsatile Tinnitus (PT) is a rhythmic sound perceived in the ear that is synchronous with the patient’s heartbeat, often described as a throbbing, whooshing, or swishing noise. Unlike the constant ringing or buzzing of non-pulsatile tinnitus, PT is caused by the ear sensing turbulent blood flow in nearby vessels. This distinction is crucial because PT is far more likely to have an identifiable underlying physical cause.
Directly Addressing the Severity of Pulsatile Tinnitus
Pulsatile tinnitus is a symptom that demands medical investigation because the concern is not the sound itself, but the underlying condition causing it. Unlike non-pulsatile tinnitus, which is commonly related to hearing loss, PT indicates a change in the vascular system or blood dynamics.
The vast majority of people who experience PT do not have a deadly condition, yet a potentially serious issue is identified in a significant percentage of cases. This means PT is rarely dismissed as a benign complaint by healthcare providers, acting instead as an important warning sign. Anyone experiencing a pulse-synchronous sound should seek consultation with a specialist like an otolaryngologist or neurologist to determine the root cause.
Common and Benign Origins of Pulsatile Tinnitus
Many causes of pulsatile tinnitus are not life-threatening and involve an increase in blood flow or a heightened awareness of normal body sounds. Conditions that increase the volume or speed of blood flow can make the turbulence audible. For instance, severe anemia or an overactive thyroid gland (hyperthyroidism) forces the heart to pump blood more rapidly, generating a louder sound.
Changes in the blood vessels themselves can also create noise, such as when the internal jugular vein develops a benign, turbulent flow called a venous hum. This rushing sound often changes when the head is turned or when light pressure is applied to the neck.
Simple mechanical issues in the ear can also increase the body’s awareness of internal sounds. Conductive hearing loss, caused by conditions like a ruptured eardrum or excess earwax, blocks external noise, making internal blood flow sounds more noticeable. Certain medications that affect blood pressure or flow can also temporarily generate this rhythmic sound as a side effect. In these scenarios, treating the underlying systemic issue or clearing the ear canal often resolves the pulsatile noise entirely.
Serious Vascular Conditions Requiring Immediate Attention
The most concerning causes of pulsatile tinnitus are those involving structural abnormalities in the blood vessels near the brain or ear. These conditions require immediate attention due to the potential for severe, long-term health consequences like stroke or vision loss. One of the more common serious diagnoses is Idiopathic Intracranial Hypertension (IIH), also called Pseudotumor Cerebri, which is an increase in pressure within the fluid surrounding the brain.
This elevated pressure can cause a narrowing, or stenosis, of the large veins in the brain, such as the transverse or sigmoid sinuses, leading to turbulent blood flow and the characteristic whooshing sound. IIH can also present with headaches and vision disturbances, making prompt diagnosis important to prevent optic nerve damage.
Another serious concern is the presence of Arteriovenous Malformations (AVMs) or Dural Arteriovenous Fistulas (DAVFs). These are abnormal, direct connections between arteries and veins that bypass the normal capillary network, causing high-pressure blood to shunt rapidly and create a loud, turbulent noise. DAVFs in particular carry a risk of intracranial hemorrhage and stroke, making them one of the most urgent causes to identify.
Narrowing of the carotid arteries (carotid artery stenosis), caused by plaque buildup (atherosclerosis), can also produce a loud, high-pitched bruit that is heard as PT.
Finally, highly vascular tumors near the base of the skull, such as paragangliomas (glomus tumors), can press on or involve blood vessels, causing a pulsatile sound. Although often benign, these tumors are slow-growing and can damage delicate structures like cranial nerves, necessitating treatment. Aneurysms and arterial dissections, which are tears in the vessel wall, are rarer but also serious causes that can be revealed by a PT investigation.
Medical Evaluation and Diagnostic Procedures
The medical evaluation for pulsatile tinnitus begins with a specialized physical examination. The provider will often listen to the patient’s head, neck, and area around the ear with a stethoscope to determine if the PT is objective (meaning the sound can be heard by the examiner). Listening for a vascular sound, known as a bruit, helps to localize the source and suggests whether the problem is arterial or venous.
If the sound is subjective, meaning only the patient hears it, imaging is almost always required to investigate the underlying cause. The most common non-invasive imaging tools are Magnetic Resonance Angiography (MRA) and Computed Tomography Angiography (CTA). MRA is particularly effective at visualizing the blood vessels and identifying structural problems like AVMs, DAVFs, or the narrowing of venous sinuses.
A CT scan, often focused on the temporal bone, is used to look for bony abnormalities, such as tumors or a dehiscent (missing) section of bone over a large blood vessel. If non-invasive imaging is inconclusive but suspicion remains high, a formal Angiography (a procedure involving a catheter and contrast dye) may be performed. The goal of this diagnostic process is to differentiate between benign origins and serious vascular conditions that require targeted treatment.