A rhythmic thumping or whooshing sound in one or both ears, often synchronized with one’s heartbeat, can be a disorienting experience. This internal sound, ranging from mildly annoying to intensely distracting, can feel like a constant reminder of one’s pulse. It is particularly noticeable in quiet environments, such as when trying to sleep, as there are fewer external noises to mask it.
What is Pulsatile Tinnitus?
Pulsatile tinnitus is the medical term for a rhythmic sound in the ear that typically beats in time with the heart. Unlike other forms of tinnitus, which involve ringing, buzzing, or hissing sounds from abnormal auditory nerve signals, pulsatile tinnitus is the perception of a real sound generated within the body. This sound usually arises from changes in blood flow or muscle movements occurring near the ear.
Underlying Causes of the Thumping
The thumping sound often stems from various issues affecting blood flow or muscular activity near the ear.
Vascular Issues
Changes in blood flow are a frequent cause of pulsatile tinnitus. Turbulent blood flow can occur when blood vessels near the ear are narrowed or have irregularities. For instance, atherosclerosis, a hardening of the arteries due to plaque buildup, can make blood flow more forceful and audible.
Narrowing of the carotid arteries in the neck or abnormalities in the jugular veins can also create a whooshing sound as blood moves through restricted spaces. Conditions such as severe anemia or an overactive thyroid gland (hyperthyroidism) can cause blood to flow more quickly throughout the body, making the sound of circulation more prominent. Arteriovenous malformations (AVMs), rare abnormal connections between arteries and veins, can also result in turbulent and louder blood flow heard as pulsatile tinnitus.
Muscular Issues
Muscle spasms in and around the ear can generate rhythmic thumping sounds. Middle ear myoclonus, a rare condition, involves involuntary contractions of the tensor tympani or stapedius muscles within the middle ear, producing clicking, thumping, or fluttering sounds. Spasms of muscles in the soft palate, located at the back of the roof of the mouth, can also cause an unusual clicking sound perceived in the ear.
Ear-Related Conditions
Structural or pressure-related issues within the ear and surrounding areas can contribute to pulsatile tinnitus. Eustachian tube dysfunction, particularly when the tube remains abnormally open (patulous Eustachian tube), can transmit sounds of breathing or blood flow to the ear. High blood pressure can also lead to pulsatile tinnitus by increasing the force of blood against vessel walls, making the flow more audible.
Benign intracranial hypertension (pseudotumor cerebri) involves increased cerebrospinal fluid pressure, which can narrow large veins draining blood from the brain, such as the transverse sinuses. This creates a whooshing sound as blood is forced through a constricted area. Abnormalities in the bony structures near the ear, such as thinning or missing bone overlying major arteries or veins, can also allow the sound of blood flow to become more pronounced.
When to Seek Medical Advice
While hearing a thumping in the ear can be unsettling, a healthcare professional should evaluate it to determine the underlying cause and ensure appropriate management. Prompt medical attention is advisable if the thumping begins suddenly or worsens significantly. Consult a doctor if the sound is accompanied by neurological symptoms like dizziness, vision changes, weakness, or numbness.
If the thumping occurs in only one ear, medical review is warranted. If the sound interferes with daily activities, concentration, or sleep, a medical evaluation can help. Individuals with pre-existing conditions like heart disease or high blood pressure should discuss new or changing ear sounds with their doctor.
How It’s Diagnosed and Treated
Diagnosing pulsatile tinnitus involves a comprehensive medical evaluation. A doctor will begin by taking a detailed medical history and performing a physical examination, often listening with a stethoscope near the ear and neck to detect any audible sounds. If a sound can be heard by the examiner, it is referred to as objective pulsatile tinnitus.
Further diagnostic steps often include imaging tests to visualize blood vessels and structures in the head and neck. Common imaging modalities include Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), Computed Tomography (CT) scans, and CT Angiography (CTA). These tests help identify vascular abnormalities, tumors, or other structural issues. Hearing tests, known as audiometry, may also assess overall hearing function.
Treatment depends on the identified underlying cause. For vascular issues, treatment might involve medication to manage blood pressure or surgical procedures like stenting to widen narrowed veins. Muscle spasms may be treated with muscle relaxants or Botox injections.
Eustachian tube dysfunction can be managed with nasal sprays, decongestants, or pressure equalization tubes. If benign intracranial hypertension is diagnosed, medication to reduce fluid pressure around the brain is prescribed. When a specific cause is not identified, management focuses on coping strategies like sound therapy or relaxation techniques.