When you settle down on a pillow, you might occasionally become aware of a rhythmic thumping or whooshing sound in your ear. This common auditory sensation, while often fleeting and harmless, can sometimes raise questions. Understanding it helps distinguish between benign occurrences and situations that might require attention.
Understanding the Sensation
Pulsatile tinnitus is the medical term for hearing a rhythmic sound that is synchronized with your pulse. This sensation occurs when the ear perceives changes in blood flow through nearby blood vessels, such as arteries and veins in the neck and at the skull’s base. Normally, ambient noise masks these internal body sounds. Lying on a pillow blocks external sounds, amplifying the subtle noises of circulating blood.
Blood flow that is faster or becomes turbulent generates more audible noise. This increased sound then transmits through bone or other tissues to the inner ear.
Common Causes of Pulsatile Tinnitus
Several common factors can lead to pulsatile tinnitus. An increase in overall blood flow, such as during strenuous exercise, pregnancy, anemia, or an overactive thyroid, can make these sounds more noticeable. High blood pressure can also contribute to this sensation, as the force of blood against vessel walls becomes more pronounced. Conditions that block the ear canal, like impacted earwax, can heighten awareness of internal sounds by muffling external ones. Similarly, some forms of conductive hearing loss, such as a perforated eardrum, can make internal body sounds more apparent.
When to Seek Medical Attention
While often benign, pulsatile tinnitus can occasionally signal an underlying health concern. Seek medical attention if the pulsing sound is persistent, occurs only in one ear, or changes in intensity or frequency. These characteristics might suggest a more specific issue.
Accompanying symptoms also warrant a medical evaluation. These include hearing loss, dizziness, headaches, vision changes, or any neurological symptoms. Such symptoms, when present with pulsatile tinnitus, could indicate conditions like increased pressure in the fluid around the brain (idiopathic intracranial hypertension), vascular malformations, or certain tumors. Though less common, a thorough assessment can help rule them out or lead to appropriate management.
Diagnosis and Management
Diagnosis typically begins with a detailed medical history and a physical examination of the head and neck. A doctor may listen to the sounds in your ear with a stethoscope, as some forms of pulsatile tinnitus can be objectively heard by an examiner. A hearing test is also performed to assess auditory function and identify any associated hearing loss.
Depending on initial findings, imaging tests may be recommended. These can include magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) to evaluate blood vessels and soft tissues, or computed tomography (CT) and CT angiography (CTA) for detailed views of bone structures and blood flow. A cerebral angiogram may be necessary if a vascular lesion is suspected.
Management varies based on the diagnosis. If a specific medical condition is identified, treatment focuses on addressing that underlying cause, which could involve medication, lifestyle adjustments, or surgical intervention. When no serious cause is found, management may involve reassurance, lifestyle modifications like managing blood pressure, or sound therapy to mask the sound.