The sensation of a throbbing or pulsing in the ears, known as pulsatile tinnitus, often aligns with the rhythm of one’s heartbeat. While unsettling, understanding its origins and management strategies can provide relief. This article explores pulsatile tinnitus, its causes, when medical attention is advised, and how healthcare professionals diagnose and treat it.
What is Pulsatile Tinnitus?
Pulsatile tinnitus is a unique form of tinnitus characterized by a rhythmic sound in the ear or head that synchronizes with the individual’s heartbeat. People often describe this sound as a whooshing, thumping, or pulsing noise. This synchronization means that if your heart rate increases, such as during exercise, the sound in your ear will also speed up.
This rhythmic quality stems from its close association with blood flow dynamics. The sounds originate from blood vessels located near the ear, including arteries and veins in the neck, at the base of the skull, and within the ear itself.
Underlying Reasons for Ear Throbbing
The throbbing sensation can arise from conditions involving changes in blood flow or the ear’s perception of internal sounds. Vascular issues are primary contributors, as alterations in blood vessels near the ear create turbulent or intensified blood flow.
Vascular Issues
High blood pressure increases the force of blood through arteries. Atherosclerosis, where fatty deposits narrow arteries, leads to uneven blood flow. Abnormalities like aneurysms (bulges), dural arteriovenous fistulas (irregular connections), or venous sinus stenosis (narrowing of brain veins) also disrupt blood flow.
Ear-Specific Conditions
Conditions directly affecting the ear can also cause pulsatile tinnitus. These include middle ear infections, excessive earwax buildup, or foreign objects, which alter sound transmission. Structural changes, such as thinning of inner ear bones (e.g., superior semicircular canal dehiscence), can make blood flow sounds more audible. Benign tumors, particularly vascular glomus tumors in the middle ear, can also create pulsatile sounds.
Other Medical Conditions
Other medical conditions can also contribute to pulsatile tinnitus. Anemia, a reduction in red blood cells, can increase blood flow velocity. An overactive thyroid gland (hyperthyroidism) speeds up heart rate, increasing blood flow. Idiopathic intracranial hypertension, involving increased brain fluid pressure, affects venous blood flow. Rarely, Paget’s disease or a history of head trauma can also be linked to ear throbbing.
Muscle Spasms and Medications
Muscle spasms in or around the ear can produce clicking or thumping sounds perceived as pulsatile. Certain medications can also induce or worsen pulsatile tinnitus as a side effect. Some acne medications can increase pressure within the brain. Nonsteroidal anti-inflammatory drugs (NSAIDs), certain diuretics, and some antibiotics can also cause or worsen ear throbbing.
When Professional Medical Advice is Needed
While pulsatile tinnitus can signal a serious underlying medical condition, it is important to seek professional medical evaluation if the throbbing sensation persists or worsens. An immediate consultation is recommended if it is accompanied by other symptoms:
- Hearing loss
- Dizziness
- Ear pain
- Headaches
- Vision changes
- Facial weakness
Pulsatile tinnitus in only one ear (unilateral) also warrants prompt medical assessment. If the ear throbbing significantly disrupts daily life, interferes with sleep, or causes distress, consulting a healthcare professional is advisable. Self-diagnosing is not recommended, as a thorough medical evaluation is necessary for proper management.
How Doctors Diagnose and Treat
Diagnosis
Diagnosing pulsatile tinnitus begins with a detailed medical history and physical examination. The doctor will inquire about the sound’s nature, duration, and any accompanying symptoms. During the exam, the healthcare provider may use a stethoscope to listen to the neck and head, as the sound can sometimes be heard objectively.
Several diagnostic tests may be ordered to pinpoint the cause. Hearing tests are performed to evaluate function. Imaging scans, including MRI, MRA, CT, CTA, and MRV, are used to visualize blood vessels and structures around the ear and brain. Blood tests may check for conditions like anemia or thyroid disorders. In specific cases, a lumbar puncture might measure cerebrospinal fluid pressure if idiopathic intracranial hypertension is suspected.
Treatment
Treatment for pulsatile tinnitus is individualized, directly addressing the underlying cause. For example, high blood pressure is managed with medication and lifestyle modifications. Bacterial ear infections are treated with antibiotics, and anemia with medication or dietary adjustments. Vascular abnormalities or tumors may require surgical intervention.
When a specific cause cannot be fully treated or identified, symptomatic relief strategies are employed. These include sound therapy using masking devices or white noise generators, and behavioral therapies like cognitive behavioral therapy or relaxation techniques. With proper diagnosis and targeted treatment, many individuals find significant improvement or complete resolution of their symptoms.