The sensation of hearing your eardrum beat in rhythm with your heart is known as pulsatile tinnitus. This experience is distinct from common forms of tinnitus, which typically involve a constant ringing, buzzing, or hissing sound not synchronized with the pulse. Pulsatile tinnitus is characterized by a rhythmic whooshing, thumping, or pulsing noise that precisely matches the rate of your heartbeat. This unique symptom is the perception of internal body sounds, primarily blood flow, that have become audible. Unlike most tinnitus, pulsatile tinnitus frequently has an identifiable physical cause related to a change in blood flow or how the ear perceives that flow.
The Mechanism Behind the Sound
Pulsatile tinnitus is classified as an objective sound, meaning the noise originates from a real internal source. The sound is generated due to the ear’s close anatomical proximity to major blood vessels, specifically the carotid artery and the jugular vein. These vessels carry blood under pressure, and any alteration in the speed, volume, or smoothness of this flow creates noise. The sound of blood surging through these vessels is normally too soft to be noticed over external noises. The physical turbulence created by the heartbeat’s pressure wave travels through bone and tissue to the inner ear structures, where it is perceived as pulsatile tinnitus when loud enough.
Vascular and Systemic Causes
The most common causes of pulsatile tinnitus result in turbulent or increased blood flow near the auditory system. Atherosclerosis, often called hardening of the arteries, is a significant contributor, where fatty deposits narrow the blood vessels. This constriction forces the blood to flow less smoothly, creating a turbulent, whooshing sound.
Systemic conditions that increase the overall volume and speed of blood flow, known as hyperdynamic circulation, can also cause the sound to become audible. Conditions like severe anemia force the heart to pump faster to compensate for low oxygen, and hyperthyroidism accelerates the heart rate. Elevated blood pressure (hypertension) increases the force exerted by the blood, resulting in a more audible flow.
Structural abnormalities in the blood vessels themselves are another source of noise. Arteriovenous malformations (AVMs) are one example, where abnormal connections between arteries and veins cause a high-velocity, turbulent flow. Benign tumors near the ear, such as glomus tumors, can also increase localized blood supply, creating a pronounced sound.
Localized Ear Issues and Amplification
Pulsatile tinnitus can also arise from an increase in the ear’s ability to hear normal internal sounds, rather than increased blood flow noise. This is often due to conductive hearing loss, where a blockage prevents external sound from effectively reaching the inner ear. When external masking sounds are diminished, the body’s own internal noises become disproportionately noticeable. Common causes of conductive hearing loss include:
- Excessive ear wax build-up.
- Fluid accumulation in the middle ear (e.g., otitis media).
- Eustachian tube dysfunction, which alters pressure balance.
- A perforated eardrum, which changes sound transmission mechanics.
In these cases, the blood flow is not turbulent; the issue is acoustic amplification within the ear structure.
When to Consult a Medical Professional
A medical evaluation is recommended for persistent pulsatile tinnitus because it can signal an underlying vascular or systemic condition. Prompt attention is particularly important if the pulsing sound is unilateral (in only one ear), suggesting a localized vascular issue or growth. Other red flag symptoms that necessitate immediate consultation include sudden onset, associated dizziness, significant hearing loss, or new neurological symptoms.
The diagnostic process begins with a thorough physical examination, where a doctor listens to the neck and around the ear for an objective sound, called a bruit. This initial assessment helps determine if the sound is truly objective and vascular in origin. Further investigation involves audiometry (hearing test) and medical imaging to visualize the blood vessels and surrounding structures. Advanced imaging techniques like Magnetic Resonance Angiography (MRA) or Computed Tomography Angiography (CTA) are used to look for vessel narrowing, malformations, or tumors, while blood tests check for systemic causes like anemia or thyroid dysfunction. Treatment depends entirely on the identified cause, ranging from simple interventions like ear wax removal or managing high blood pressure, to specialized procedures for correcting complex vascular abnormalities.