Tinnitus, the perception of sound without an external source, often manifests as ringing or buzzing. A distinct type, known as pulsatile tinnitus, is characterized by a rhythmic sound that synchronizes with an individual’s heartbeat. This unique characteristic often raises concerns about its origin and seriousness. Unlike other forms of tinnitus, the pulsatile nature suggests a direct connection to the body’s circulatory system.
What is Pulsatile Tinnitus?
Pulsatile tinnitus presents as a rhythmic noise, commonly described as a whooshing, throbbing, humming, or clicking sound in the ear or head. This sound consistently aligns with the person’s pulse. People can often confirm this synchronization by checking their pulse at the wrist or neck while listening to the sound. While other forms of tinnitus are often linked to issues with how the brain interprets sound, pulsatile tinnitus has a physical source related to blood flow. The sound originates from turbulent blood flow within vessels located close to the inner ear, such as arteries and veins in the neck, skull base, or within the ear itself.
Recognizing Urgent Symptoms
While pulsatile tinnitus can sometimes be benign, certain accompanying symptoms indicate a need for prompt medical attention. A sudden onset of pulsatile tinnitus should be evaluated, especially if it appears without clear explanation. Changes in hearing, such as sudden hearing loss or a decrease in hearing, warrant immediate investigation. Other concerning symptoms include dizziness or balance issues, which can suggest problems affecting the inner ear or neurological pathways.
Vision changes, such as blurred vision, double vision, or temporary loss of sight, are serious indicators. Persistent or severe headaches, especially if new or worsening, are also concerning. Weakness or numbness in any part of the body, or if the pulsatile sound is experienced in only one ear (unilateral), also requires urgent medical assessment. These symptoms, when present with pulsatile tinnitus, suggest a serious underlying condition that requires timely diagnosis to prevent further complications.
Underlying Causes and Their Significance
Pulsatile tinnitus can stem from various medical conditions, each with varying urgency and severity. Vascular issues are a common category, where altered blood flow near the ear generates the audible sound. For instance, aneurysms, weakened, bulging areas in artery walls, can cause pulsatile tinnitus due to abnormal blood flow and carry the risk of rupture. Arteriovenous malformations (AVMs), abnormal tangles of blood vessels connecting arteries and veins, create turbulent flow that can be heard.
Conditions like carotid artery disease, involving narrowing of the arteries in the neck that supply blood to the brain, can also lead to pulsatile tinnitus as blood flow becomes turbulent. Venous sinus stenosis, a narrowing of the large veins in the brain that drain blood, can similarly produce a whooshing sound due to restricted flow. Atherosclerosis, or hardening of the arteries, creates irregular vessel surfaces that cause noisy, turbulent blood flow. These vascular conditions can indicate a risk of stroke or other serious complications.
Ear-related conditions can also be responsible for pulsatile tinnitus. Glomus tumors, typically benign but highly vascular growths found in the middle ear or near the jugular vein, can cause a pulsing sound as blood flows through them and presses on ear structures. Otosclerosis, a condition where abnormal bone growth in the middle ear affects hearing, can make internal body sounds more noticeable. Conductive hearing loss, caused by issues that prevent sound from reaching the inner ear, can also heighten awareness of internal blood flow sounds.
Other systemic conditions may also manifest as pulsatile tinnitus. High blood pressure (hypertension) can increase the force of blood flow through vessels, making it audible, and unmanaged hypertension is a common cause. Anemia, a deficiency in red blood cells or hemoglobin, can cause the heart to pump harder to deliver oxygen, leading to increased and audible blood flow. Hyperthyroidism, an overactive thyroid gland, can accelerate heart rate and blood flow, contributing to the sound. Idiopathic intracranial hypertension (IIH), a condition characterized by increased pressure around the brain, can also induce pulsatile tinnitus by compressing venous sinuses and altering blood flow.
Medical Evaluation and Next Steps
A thorough medical evaluation is important for anyone experiencing pulsatile tinnitus, particularly if urgent symptoms are present. The diagnostic process begins with a detailed medical history, where a doctor will inquire about the characteristics of the sound and any associated symptoms. A physical examination will follow, including listening to the neck and head with a stethoscope to detect any objective sounds the examiner can hear. If the sound can be heard by the doctor, it is referred to as objective pulsatile tinnitus.
Further diagnostic tests may be ordered to identify the underlying cause. Audiometry can assess hearing function and rule out hearing loss. Imaging studies are used to visualize blood vessels and structures near the ear and brain. These include Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), Computed Tomography (CT) scans, or CT Angiography (CTA), which provide detailed images of soft tissues and blood vessels.
Sometimes, a more invasive procedure like angiography, which involves injecting dye into blood vessels to make them visible on X-rays, may be performed. The goal of these evaluations is to pinpoint the specific cause, as treatment focuses on addressing the identified underlying condition.