Hearing a persistent whooshing, throbbing, or thumping sound in your ears that follows the rhythm of your pulse can be unsettling. This sensation is a specific form of internal sound perception. It indicates that your auditory system is picking up on the amplified sounds of blood flow within the major vessels near your ear structures. While alarming, this symptom often directs medical professionals toward an identifiable cause that is manageable once properly diagnosed.
Understanding Pulsatile Tinnitus
The perception of sound without an external source is known as tinnitus, but the rhythmic type is specifically called pulsatile tinnitus. This condition is distinct from common forms of tinnitus, which are typically described as a continuous ringing, buzzing, or hissing sound. Non-pulsatile tinnitus is usually linked to issues within the auditory nerve or the brain’s processing of sound.
Pulsatile tinnitus, in contrast, is frequently generated by mechanical sound waves created by blood moving through vessels close to the ear. The ear is anatomically near major vascular structures, including the carotid artery and the jugular vein, which run through the neck and skull base. This proximity means that any change in the volume or character of blood flow can be amplified and picked up by the inner ear. The sound is perceived as pulsing because the blood flow is synchronized with the heart’s pumping action.
Causes Related to Blood Vessel Changes
The most common causes of pulsatile tinnitus involve conditions that alter the smooth flow of blood through vessels, leading to turbulence. When blood moves through a narrowed or irregular vessel, the flow changes from smooth to turbulent, creating an audible noise. This turbulent flow is then transmitted through the surrounding bone and tissue to the inner ear.
Conditions that cause increased or high-volume blood flow throughout the body can also lead to pulsatile tinnitus. Severe anemia, hyperthyroidism, and pregnancy can raise the heart’s output, forcing blood to move faster. This accelerated movement makes the sound of blood flow more audible to the sensitive structures of the ear.
Structural abnormalities or diseases affecting the vessel walls are another major contributor. Atherosclerosis, which involves the hardening and narrowing of arteries due to plaque buildup, is a frequent vascular cause. When the carotid arteries in the neck are narrowed (carotid stenosis), the blood flow becomes turbulent and can be heard on the same side as the affected artery.
High blood pressure, or hypertension, increases the force with which blood is pushed against the vessel walls, amplifying the sound of the pulse. Rare causes include abnormal connections between arteries and veins known as arteriovenous (AV) malformations. These malformations create a short circuit that causes blood to flow rapidly and turbulently, generating a loud sound. Venous issues, such as a narrowing in the large veins that drain blood from the brain (venous sinus stenosis), can also cause pulsatile tinnitus.
Localized Sources Within the Ear
Pulsatile tinnitus can also originate from localized changes within the ear structure that amplify internal sounds. The ear is designed to block out most internal body sounds to focus on external noise, but certain conditions can disrupt this natural dampening mechanism.
Conductive hearing issues, where the transmission of sound is blocked, can make internal sounds more noticeable. This occurs when an obstruction, such as excessive earwax or fluid buildup from a middle ear infection, prevents external sounds from reaching the inner ear. By blocking outside noise, these issues effectively turn up the volume on the patient’s own internal sounds, including their pulse.
Pressure changes caused by eustachian tube dysfunction can alter the pressure balance in the middle ear, making the sound of nearby blood flow more pronounced. Structural anomalies of the temporal bone, such as a high-riding or dehiscent jugular bulb, mean that the large jugular vein is unusually close to the middle ear. This decreased separation allows the sound of blood moving through the vein to be more easily transmitted to the auditory system.
Rarely, the pulsatile sound can be caused by highly vascularized benign tumors, such as glomus tumors, that grow near the middle ear. These growths contain numerous blood vessels, and the sound of blood flowing through the tumor’s vessels can be perceived as pulsatile tinnitus. The presence of a persistent stapedial artery can also generate the sound due to its close proximity to the ear structures.
Medical Steps for Diagnosis and Treatment
Since pulsatile tinnitus often points to an underlying medical condition, a thorough evaluation by a healthcare provider is necessary. The initial diagnostic process begins with a detailed history and a physical examination, including listening with a stethoscope over the ear, neck, and skull. If the doctor can also hear the rhythmic sound, it is categorized as objective pulsatile tinnitus, which suggests a vascular cause.
The physician may perform specific tests during the examination, such as applying gentle pressure to the jugular vein in the neck. If this action temporarily reduces or stops the sound, it suggests the cause is venous in origin. Imaging studies are often required following the physical exam to visualize the blood vessels and surrounding structures.
The most common imaging modalities include Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans, often combined with angiography (MRA or CTA) to focus on the arteries and veins. These scans help identify issues like carotid stenosis, venous sinus narrowing, or the presence of an AV malformation or a tumor. The choice of imaging is determined by the patient’s symptoms and physical exam findings.
Treatment for pulsatile tinnitus is dependent on successfully identifying and addressing the root cause. If the sound is caused by high blood pressure, managing hypertension with medication and lifestyle changes is the primary approach. For localized issues like earwax impaction, simple removal can resolve the symptom. If a significant vascular problem, such as a severe stenosis or an AV malformation, is identified, treatment may involve procedures like stenting or specialized surgery to correct the abnormal blood flow.