Pulsatile tinnitus is a distinct auditory sensation where the perceived sound matches the rhythm of a person’s heartbeat or pulse. Unlike the more common form of tinnitus, which is typically described as a continuous ringing, buzzing, or hissing, pulsatile tinnitus is characterized by a rhythmic thumping, whooshing, or swooshing noise. This difference is significant because the rhythmic sound almost always originates from a physical, detectable source, most often related to blood flow in vessels near the ear. When this symptom intensifies during physical activity, it is a direct consequence of the body’s temporary response to exertion, which amplifies an existing underlying condition.
The Physiological Mechanism of Exertion-Induced Sound
Physical exertion immediately triggers temporary hemodynamic changes designed to oxygenate working muscles. The most noticeable change is the sharp increase in cardiac output, which is the volume of blood pumped by the heart per minute. This higher output forces blood to move faster through the arteries and veins that pass near the inner and middle ear structures.
This rapid transit of blood generates more acoustic energy, which is transmitted to the auditory apparatus. Additionally, exercise causes an elevation in systolic blood pressure, increasing the force of the blood flowing through vessels. The combination of faster, higher-pressure blood flow creates a louder, more turbulent sound that is more easily perceived near the ear.
The body’s major vessels, particularly the carotid artery and jugular vein, run in close proximity to the ear canal and cochlea. Normally, the sound of smooth blood flow is too quiet for the brain to register. However, during exercise, the volume of this internal sound is effectively turned up, momentarily revealing any pre-existing irregularity in the vascular system.
Key Underlying Conditions Revealed by Exercise
While exercise only amplifies the sound, the persistence of pulsatile tinnitus suggests a structural or systemic factor creating an abnormal noise.
Vascular abnormalities are a frequent cause, as they directly disrupt the smooth flow of blood. Conditions like atherosclerosis, or hardening of the arteries, create rough or narrowed passages, causing blood flow to become turbulent and noisy. Structural issues such as aneurysms or arteriovenous malformations (AVMs) near the ear create abnormal pressure gradients or shunts. The increased blood pressure from exercise makes the resulting whooshing sound louder. Abnormalities in the venous system, such as a high-riding jugular bulb or a sigmoid sinus diverticulum, also become noisier with elevated venous blood return during physical activity.
Systemic conditions affecting blood composition or circulation can also be revealed by exercise. Anemia reduces the oxygen-carrying capacity of the blood, prompting the heart to compensate by increasing overall blood flow speed and volume. This high-flow state, exacerbated by exercise demands, generates more noise. Hyperthyroidism, an overactive thyroid gland, similarly drives up the body’s metabolism and heart rate, leading to faster circulation and a more audible pulse.
Conditions related to increased pressure within the skull, such as idiopathic intracranial hypertension (IIH), form another category. IIH involves a buildup of cerebrospinal fluid around the brain, which puts pressure on the veins that drain blood from the head. The combination of this chronic pressure and the temporary rise in blood pressure from exertion can increase the sound of blood flow in the ear.
Finally, conductive hearing loss, where external sounds are muffled, can make a person more aware of their own body sounds. This means an otherwise normal internal sound becomes audible during exercise.
When Immediate Medical Evaluation Is Necessary
While the symptom is often temporary, certain characteristics of pulsatile tinnitus warrant immediate medical consultation to rule out serious underlying issues. Pulsatile tinnitus heard only in one ear (unilateral) is a red flag. This one-sided presentation often suggests a localized structural problem, such as a vascular abnormality or a tumor, requiring prompt investigation.
Any pulsatile sound accompanied by neurological symptoms demands urgent attention. These include sudden or severe headaches, dizziness, balance problems, vision changes, or facial weakness. Such combinations may signal a vascular event or a pressure issue near the brain, where rapid diagnosis is crucial.
The sudden onset of pulsatile tinnitus without a clear trigger, or if the sound persists for hours or days after exercise cessation, is also concerning. The initial medical evaluation begins with a thorough history and a physical examination that includes auscultation. Auscultation is when a doctor listens with a stethoscope over the neck and head to determine if the sound is objective (audible to the examiner). If a specific cause is suspected, diagnosis progresses to specialized imaging tests like computed tomography (CT) or magnetic resonance imaging (MRI) of the head and neck to visualize the blood vessels and surrounding structures.