Pulsatile tinnitus is a distinct type of tinnitus where individuals perceive rhythmic sounds synchronized with their heartbeat. This sensation, which might include whooshing, thumping, or roaring, can sometimes be temporarily alleviated by applying pressure to the neck. This temporary relief points to an underlying physical cause that warrants medical attention. Understanding its mechanisms is important for comprehending its potential implications.
Understanding Pulsatile Tinnitus
Pulsatile tinnitus presents as a rhythmic noise, such as a whooshing, thumping, or humming, that typically aligns with one’s pulse or heartbeat. The sound often speeds up with physical exertion and slows down with rest. Unlike non-pulsatile tinnitus, which is commonly described as a constant ringing, buzzing, or hissing, pulsatile tinnitus often indicates an identifiable, underlying physical condition.
The key difference lies in its origin; non-pulsatile tinnitus can stem from various auditory pathway issues, while pulsatile tinnitus usually arises from changes in blood flow within vessels near the ear or an increased awareness of that blood flow. Its investigation is important, as it can sometimes be the first sign of a more serious medical issue. Recognizing this distinction aids proper diagnosis and management.
Why Neck Pressure Provides Temporary Relief
Applying pressure to the neck can temporarily reduce or stop pulsatile tinnitus by altering blood flow dynamics in major vessels. This action often compresses the internal jugular vein, a large vein draining blood from the brain. Momentarily restricting blood flow through this vein can reduce the turbulence causing the pulsatile sound.
This temporary alleviation suggests the sound originates from vascular structures in the head or neck. This relief is only momentary and does not address the root cause of the turbulent blood flow or the underlying condition. The mechanism involves a physical change in pressure on blood vessels, which can temporarily dampen the sound transmitted to the inner ear.
Potential Underlying Causes
Pulsatile tinnitus often signals underlying medical conditions, particularly those affecting blood vessels in the head and neck. Common vascular issues include:
Venous hum, a benign turbulent flow in the jugular vein.
Dural arteriovenous fistulas (dAVFs), abnormal connections between arteries and veins in the brain’s covering.
Atherosclerosis, characterized by the hardening and narrowing of arteries.
Carotid artery disease, involving narrowing of the arteries supplying blood to the brain.
These conditions create turbulent blood flow that becomes audible.
Conditions that increase overall blood flow can also make existing vascular sounds more noticeable. Anemia, particularly iron-deficiency anemia, can cause the heart to pump harder, leading to increased blood flow and audible turbulence. Similarly, hyperthyroidism, an overactive thyroid gland, accelerates heart rate and blood flow, which can manifest as pulsatile tinnitus.
Increased intracranial pressure is another significant factor. Idiopathic Intracranial Hypertension (IIH), also known as pseudotumor cerebri, involves elevated pressure around the brain that can affect venous drainage and cause pulsatile sounds. This condition frequently affects overweight women of childbearing age.
Seeking Medical Evaluation and Treatment
Anyone experiencing pulsatile tinnitus, especially if temporarily relieved by neck pressure, should consult a healthcare professional. Specialists like an otolaryngologist (ENT), neurologist, or a primary care physician for referral, can help identify the underlying cause. Although the symptom might seem minor, it frequently indicates a treatable underlying condition.
The diagnostic process typically involves a thorough medical history, a physical examination, and various imaging tests to pinpoint the source of the sound. Imaging options include:
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Angiography (MRA)
Computed Tomography (CT) scans
CT Angiography (CTA)
Venography
Blood tests may also be conducted to check for conditions like anemia or thyroid issues. Treatment depends on the identified underlying cause, ranging from medications to manage blood pressure or intracranial pressure, to more invasive procedures like embolization or surgery for vascular malformations.