A rhythmic, throbbing sound perceived inside the ear is often described as hearing a helicopter or a continuous whooshing. This specific auditory symptom is distinct from the more common forms of tinnitus, which typically involve a steady, high-pitched ringing or buzzing noise. The sound is often synchronized with the person’s heartbeat, making it a unique internal noise that can be particularly noticeable during quiet moments or at night. Because this rhythmic sound frequently points toward an identifiable physical source, a thorough medical evaluation is the recommended next step.
Understanding Pulsatile Tinnitus
The sensation of hearing a pulse-synchronized noise is officially known as pulsatile tinnitus (PT). This relatively rare form is frequently the result of a sound that is physically generated and transmitted to the inner ear, unlike standard tinnitus which is often considered a phantom noise from abnormal nerve activity. PT is an amplified perception of internal bodily functions, specifically the rush of blood flow. The sound is often described as a repetitive thumping, whooshing, or swooshing noise that can be verified by checking one’s own pulse simultaneously.
The underlying mechanism involves the ear perceiving turbulent blood flow or increased blood volume in vessels located near the hearing structures. Since blood vessels like the carotid artery and jugular vein run in close proximity to the middle and inner ear, any change in the velocity or smoothness of the blood moving through them can become audible. This rhythmic sound can sometimes be heard by a doctor using a stethoscope placed near the ear or neck, classifying it as “objective” tinnitus.
Circulatory Causes of Rhythmic Ear Noise
The most common and significant causes of pulsatile tinnitus are linked to the circulatory system, where changes in blood flow dynamics create noise.
Hyperdynamic States
Conditions that lead to a hyperdynamic state cause blood to flow with increased speed and volume throughout the body. Severe anemia or an overactive thyroid gland (hyperthyroidism) can accelerate the heart rate and blood flow, leading to a louder perception of circulation near the ear.
Vascular Turbulence
Turbulence in blood vessels near the head and neck is a major cause. Atherosclerosis, the buildup of plaque inside arteries, narrows the pathways and makes the blood flow uneven and noisy, much like water rushing through a constricted pipe. High blood pressure (hypertension) also contributes by increasing the force of blood against the vessel walls, making the forceful pulse more audible.
Structural Abnormalities
Structural abnormalities in the vessels also play a part. These include arteriovenous malformations (AVMs) or dural arteriovenous fistulas, which are abnormal connections between arteries and veins that bypass the capillary network, leading to high-pressure, turbulent flow that is easily heard. Highly vascular tumors, such as glomus tumors, can press against veins or create their own network of noisy blood vessels, generating a distinct pulse-synchronous sound. Increased blood flow in the veins, such as with structural anomalies in the sigmoid sinus or Idiopathic Intracranial Hypertension (IIH), can also become a source of rhythmic noise.
Mechanical and Structural Factors
Rhythmic sounds that mimic pulsatile tinnitus can be caused by structural or mechanical issues within or surrounding the ear, rather than blood flow alone.
Middle Ear Conditions
The middle ear space is meant to be air-filled. Conditions like middle ear effusion (fluid buildup often due to infection or allergies) can dampen external sounds while amplifying internal ones. This fluid acts as a conductor, making the sounds of normal blood flow suddenly much more noticeable. Similarly, cerumen (earwax) impaction or Eustachian tube dysfunction can cause a temporary conductive hearing loss, blocking ambient noise and increasing the awareness of the body’s internal sounds.
Vascular Proximity
Abnormalities in the bone near the ear are structural factors, such as a high-riding jugular bulb or an aberrant carotid artery. These conditions involve a vessel being positioned unusually close to or partially protruding into the middle ear space, making the normal pulsations of blood more readily transmitted to the inner ear.
Muscle Activity
Objective rhythmic sounds can also be generated by muscle activity, a phenomenon known as middle ear myoclonus or palatal myoclonus. This involves involuntary, rhythmic spasms of the tiny muscles attached to the middle ear bones (like the stapedius or tensor tympani) or the muscles in the soft palate. These spasms produce a rapid, repetitive clicking or thumping sound that, while rhythmic, may not be strictly synchronized with the heart rate, distinguishing it from purely vascular causes.
Medical Evaluation and Management
Because pulsatile tinnitus can be the first sign of a serious underlying condition, such as vascular abnormalities or increased intracranial pressure, a prompt medical evaluation is important. The initial assessment typically involves a detailed medical history, including whether the sound is unilateral or bilateral and if it changes when the head is turned or the neck is compressed. During a physical exam, a healthcare provider will perform an otoscopy to inspect the eardrum for any visible masses, such as a glomus tumor, which might appear as a reddish or blueish mass behind the eardrum.
The doctor will often use a stethoscope to listen over the ear, neck, and skull for a bruit, the medical term for the turbulent sound generated by abnormal blood flow. If the sound is heard by the examiner, it is classified as objective pulsatile tinnitus and points strongly toward a vascular cause. Further diagnosis relies heavily on specialized imaging to visualize the arteries and veins in the head and neck:
- Magnetic Resonance Angiography (MRA)
- Computed Tomography Angiography (CTA)
Blood tests may also be ordered to rule out systemic causes like anemia or thyroid disorders.
Management is focused on treating the identified underlying cause. If a systemic issue like high blood pressure is found, medication and lifestyle changes are the primary treatment. For complex vascular issues, such as arteriovenous malformations or severe vessel narrowing, specialized procedures like stenting or surgical repair may be necessary. When the cause is benign, such as a middle ear effusion, the sound often resolves once the fluid drains or the temporary conductive hearing loss is corrected.