The sound of one’s heart beating in the ear can be a disconcerting experience. This unique symptom is medically known as pulsatile tinnitus. Unlike the more common form of ear noise, which is typically a steady ringing or static buzzing, pulsatile tinnitus is characterized by its distinct timing. The noise is synchronized precisely with the body’s circulatory rhythm, meaning you are hearing an amplified sound of your own blood flow near the auditory structures.
Understanding Pulsatile Tinnitus
Pulsatile tinnitus is fundamentally a somatosound, meaning it is a noise generated by physiological processes within the body that the ear perceives. The ear is located near major blood vessels, including the carotid artery and jugular vein, which carry blood to and from the head. Normally, the sound of blood moving through these vessels is too faint or smooth to be consciously perceived. When the sound becomes noticeable, it suggests either a change in the physical properties of the blood flow or an alteration in the way the ear transmits or perceives internal sound.
The rhythmic, pulsating nature of the sound distinguishes it from non-pulsatile tinnitus, which is usually a static or continuous sound like a hiss or high-pitched ring. Non-pulsatile forms are often related to nerve damage or hearing loss, while the pulsing type almost always has a vascular or mechanical origin. The perceived whooshing or throbbing sound can often be confirmed by placing a finger on the wrist or neck to check the pulse simultaneously.
Common and Temporary Explanations
The most frequent causes of pulsatile tinnitus are often benign and temporary, stemming from factors that momentarily increase blood flow or amplify internal sound. Strenuous physical activity, for example, increases the speed and volume of blood pumped by the heart, causing the flow in vessels near the ear to become temporarily louder. Similarly, states of heightened stress or anxiety can elevate heart rate and blood pressure, leading to a transient perception of the pulse in the ear.
Blockages or obstructions in the outer or middle ear can also cause this phenomenon by increasing the ear’s sensitivity to internal body sounds. A simple buildup of cerumen, or earwax, against the eardrum can create a conductive hearing loss that allows internal noises to be heard more prominently. Likewise, temporary congestion or fluid accumulation in the middle ear, such as from a cold or Eustachian tube dysfunction, can prevent external sounds from entering and mask the internal sounds.
Systemic conditions may also cause temporary pulsatile tinnitus. Mild anemia, a condition where the blood lacks sufficient healthy red blood cells, causes the heart to pump faster to compensate, resulting in a louder flow. An overactive thyroid gland, or hyperthyroidism, can also speed up the metabolism and heart rate, leading to a temporary increase in the audibility of vascular sounds near the ear.
Vascular and Structural Causes
When the sound is persistent, it is often related to conditions that cause chronic changes in blood vessel structure or flow dynamics. A common mechanism involves turbulent blood flow, which occurs when blood moves through vessels that are narrowed or have irregular inner surfaces. Atherosclerosis, or the hardening of arteries due to plaque buildup, can create such irregularities in the carotid arteries near the ear, causing the blood to flow noisily.
Changes in the pressure or volume of blood returning to the heart can also be a factor, often involving the large veins in the head. A condition known as idiopathic intracranial hypertension (IIH) causes increased pressure of the fluid surrounding the brain, which can press on and narrow the venous sinuses. This narrowing, or stenosis, disrupts the smooth flow of venous blood, generating a whooshing sound that the inner ear detects.
Causes also include vascular malformations where there are abnormal connections between arteries and veins, such as an arteriovenous malformation (AVM) or fistula. These direct connections create a high-pressure, high-flow situation that generates a distinct and often loud pulsating sound. Additionally, highly vascular tumors, such as glomus tumors located near the middle ear or skull base, can increase localized blood flow or press against blood vessels, causing the characteristic rhythmic throbbing.
When Medical Consultation is Necessary
The symptom should be medically evaluated, especially if it persists. A medical consultation is appropriate if the pulsatile sound does not resolve within a few days or weeks, or if it occurs only in one ear. Unilateral pulsatile tinnitus suggests a localized cause, warranting a closer look at the local vessels or structures.
It is important to seek professional help if the pulsing noise is accompanied by other symptoms that may indicate a systemic or neurological issue. These concerning indicators include persistent headaches, dizziness, loss of balance, or changes in vision. A medical provider will often begin by checking blood pressure and may order imaging tests, such as a CT or MRI scan, to visualize the blood vessels and surrounding anatomy and identify the underlying source of the sound.