Hearing a heartbeat in your ear is a specific type of tinnitus known as pulsatile tinnitus. This phenomenon occurs when individuals perceive a rhythmic sound, often described as a whooshing or thumping, that aligns with their own pulse. It is a common concern that often points to activity within the body’s circulatory system.
Understanding the Sound
Pulsatile tinnitus is rhythmic and synchronized with the heartbeat. The sound can be described as a whooshing, thumping, or roaring, and it may be more noticeable in quiet environments or when lying down. This sound is typically heard when the ear becomes aware of changes in blood flow within nearby blood vessels, including those in the neck, at the base of the skull, or within the ear itself. Unlike other forms of tinnitus, which often stem from brain interpretation, pulsatile tinnitus usually has a physical source related to blood circulation.
Common Medical Reasons
Pulsatile tinnitus can stem from various medical conditions, many of which involve changes in blood flow near the ear.
Vascular Causes
Vascular causes are a frequent category. Conditions like atherosclerosis, or hardening of the arteries, create uneven and louder blood flow due to the lumpy inner surfaces of blood vessels. Aneurysms, which are bulges in blood vessels, can also lead to pulsatile tinnitus due to abnormal blood flow patterns. Arteriovenous malformations, which are tangles of blood vessels connecting arteries and veins, can similarly alter blood flow and cause this sound.
High blood pressure, also known as hypertension, can increase the force of blood against vessel walls, making the sound of blood flow more noticeable. Narrowing of large veins in the head and neck, such as the transverse and sigmoid sinuses or the jugular vein, can also disrupt blood flow and produce a whooshing sound.
Ear-Related Causes
Ear-related causes can also contribute to pulsatile tinnitus. Glomus tumors, which are small tumors in the middle ear with many blood vessels, can cause the perception of blood flowing through them. Conditions that cause conductive hearing loss, such as a perforated eardrum or fluid in the middle ear, can heighten an individual’s awareness of internal body sounds, including blood flow. A high-riding jugular bulb, a normal anatomical variation where the jugular vein extends higher into the middle ear, may also be a source.
Other Systemic Causes
Other systemic causes can lead to pulsatile tinnitus. Anemia, a condition characterized by a low red blood cell count, can increase overall blood flow, making it louder. An overactive thyroid gland (hyperthyroidism) can also lead to increased blood flow throughout the body. Idiopathic intracranial hypertension, a condition where cerebrospinal fluid builds up around the brain, increases pressure on blood vessels and can affect blood flow, commonly causing pulsatile tinnitus along with headaches and vision problems.
When to Consult a Doctor
Seeking medical attention is advisable if you experience pulsatile tinnitus, especially if it is a new symptom, persists, or worsens over time. While often benign, this type of tinnitus can sometimes signal an underlying condition that requires diagnosis and management. It is important to consult a healthcare professional if the sound is accompanied by other symptoms such as dizziness, hearing loss, changes in vision, or headaches. These additional symptoms could indicate a more serious underlying issue that needs prompt evaluation. Early intervention can help prevent serious complications associated with certain vascular abnormalities.
Diagnosis and Management
Diagnosing the cause of pulsatile tinnitus begins with a thorough medical history and a physical examination of the head and neck. A healthcare provider may inquire about the specific characteristics of the sound and any accompanying symptoms. This initial assessment helps to differentiate pulsatile tinnitus from other forms of tinnitus and guides further investigation.
Imaging studies are used to identify the underlying source of the sound. These include magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), which provide detailed views of blood vessels in the head and neck. Computed tomography (CT) scans, computerized tomographic angiography (CTA), and ultrasound can also be used to visualize vascular structures and identify abnormalities. In some cases, an angiogram, an X-ray of blood vessels using contrast material, may be performed for a detailed assessment.
Management of pulsatile tinnitus focuses on addressing the identified underlying condition. For example, if high blood pressure is the cause, medication and lifestyle adjustments such as exercise and smoking cessation may be recommended. If a specific vascular abnormality is found, treatment may involve medical management or, sometimes, interventional procedures. When no serious underlying cause is identified, management strategies may include lifestyle adjustments or sound therapy, such as using white noise machines or wearable sound generators, to help mask the perceived sound. Relaxation techniques, including breathing exercises and meditation, can also help reduce the impact of pulsatile tinnitus on daily life.