When you hear a rhythmic thumping or whooshing sound in your ears that consistently matches the beat of your heart, you are experiencing pulsatile tinnitus. This sensation is distinct from the more common form of tinnitus, which involves a constant ringing, buzzing, or hissing noise that does not synchronize with the pulse. The sound is often described as a throbbing or swooshing noise, representing the perception of your own blood flow. Unlike standard tinnitus, pulsatile tinnitus can sometimes be heard by a doctor using a stethoscope, classifying it as an objective form of tinnitus.
Understanding Pulsatile Tinnitus
The perception of this internal sound is possible due to the proximity of the ear’s delicate structures to major blood vessels. The middle and inner ear lie close to the carotid artery, which carries oxygenated blood to the head, and the large jugular vein, which drains blood away from the brain. Normally, blood flows through these vessels smoothly and silently.
Pulsatile tinnitus occurs when this typical blood flow is altered, creating a turbulent or amplified noise that the ear perceives. This change may be caused by an increase in the speed or volume of blood flow, or by an abnormality in the vessel structure itself. The inner ear acts like a sensitive microphone, picking up these amplified vibrations, which are then interpreted by the brain as a rhythmic sound synchronized with the heart’s pumping action.
Identifying Potential Causes
The causes of pulsatile tinnitus generally relate to the circulatory system, where changes in blood flow volume or vessel structure create turbulence.
Systemic and Flow-Related Causes
Conditions that increase the overall volume and velocity of blood flow can lead to a louder, more noticeable pulse sound. Examples include severe anemia or an overactive thyroid gland. High blood pressure, or hypertension, can also increase the force of blood against the vessel walls, making the flow more turbulent and audible near the ear.
Vascular Abnormalities
Structural abnormalities within the blood vessels are a frequent cause of this rhythmic sound. Atherosclerosis, which is the hardening and narrowing of arteries due to plaque buildup, creates uneven surfaces that disrupt smooth blood flow. Issues in large veins, known as venous causes, are also common, such as venous sinus stenosis, which is a narrowing of the veins that drain blood from the brain. Sometimes, a small pouch on the wall of a large vein, called a sigmoid sinus diverticulum, can amplify the sound of blood flow.
Local Structural Issues
Structural issues located near the ear can also contribute to or amplify pulsatile tinnitus. Certain tumors, such as glomus tumors, are highly vascular and can press against nearby blood vessels, generating a pulsing noise. Additionally, conditions that cause conductive hearing loss—like fluid in the middle ear or a perforated eardrum—can inadvertently make internal body sounds more apparent by blocking external noise.
Idiopathic Intracranial Hypertension (IIH)
A significant cause is Idiopathic Intracranial Hypertension (IIH), a condition involving elevated pressure of the cerebrospinal fluid surrounding the brain. This increased pressure affects nearby veins, often causing them to narrow, which generates a pulsing sound transmitted to the ear. IIH is often seen in younger women and may be accompanied by headaches and visual changes.
Diagnostic Procedures
Evaluation typically begins with a thorough physical examination and detailed patient history. The doctor will use a stethoscope to listen to the head, neck, and sometimes the eye area to determine if the sound is objective. They will also check for specific signs, such as a change in sound intensity when gentle pressure is applied to the jugular vein.
Following the initial assessment, an audiologic evaluation is often performed to check for any associated hearing loss. Imaging studies are usually the next step to visualize the blood vessels and surrounding structures, which helps pinpoint the exact cause.
Advanced techniques like Computed Tomography Angiography (CTA) or Magnetic Resonance Angiography (MRA) are commonly used to create detailed images of the arteries and veins in the head and neck. These scans can reveal vessel narrowing, abnormal formations, or structural anomalies near the ear. A CT scan of the temporal bone may also be ordered if a bony abnormality is suspected, providing fine detail of the middle and inner ear anatomy.
Specialized blood tests may be conducted to rule out systemic causes, such as anemia or a thyroid disorder. If the pulsatile tinnitus is accompanied by sudden neurological symptoms, including severe dizziness or vision changes, immediate medical evaluation is necessary.
Treatment Approaches and Outlook
Successful treatment for pulsatile tinnitus depends directly on the accurate identification of the underlying cause. Masking the sound is generally not the primary approach, as the symptom often signals a treatable condition.
If the diagnosis reveals a systemic issue, such as hypertension or anemia, treatment involves managing that particular condition. For instance, if high blood pressure is the source, the plan includes medication to lower blood pressure combined with appropriate lifestyle adjustments.
When a structural issue in a blood vessel is identified, procedures may be necessary. These can involve minimally invasive techniques, such as placing a stent to widen a narrowed vein or a localized procedure to correct a vessel wall abnormality. If the tinnitus is linked to a highly vascular tumor, surgical removal or other targeted therapies are often employed.
If the cause is benign or cannot be definitively identified, management techniques become the focus. These include sound therapy, such as using white noise machines to mask the sound, or behavioral therapies to reduce the annoyance and stress associated with the pulsing. With a clear diagnosis, the outlook for reducing or eliminating pulsatile tinnitus is generally favorable.