A pulsing sound heard within the ear, often described as a thumping or whooshing sensation, can be disquieting. While frequently temporary and benign, this internal noise can occasionally signal underlying health conditions that warrant closer examination.
What is Pulsatile Tinnitus?
Pulsatile tinnitus is a rhythmic sound perceived in the head or ears, typically synchronizing with one’s heartbeat. This differs from common forms of tinnitus, which often present as a continuous ringing, buzzing, or hissing sound. The rhythmic nature of pulsatile tinnitus means the sound often quickens with exertion and slows with rest, mirroring the body’s circulatory rhythm. It is often linked to blood flow changes or muscle activity in proximity to the ear structures.
Common Explanations for Ear Thumping
Excessive earwax buildup (cerumen impaction) is a frequent culprit, obstructing the ear canal. While not a direct cause of pulsatile tinnitus, it can amplify internal body sounds by blocking external noise, making blood flow more noticeable.
Temporary Eustachian tube dysfunction, often experienced during colds, allergies, or changes in altitude, can also contribute. When the Eustachian tube, connecting the middle ear to the back of the throat, does not open and close properly, it can create pressure imbalances. These imbalances may lead to a feeling of fullness or thumping as internal sounds become more pronounced.
Involuntary spasms of the tiny muscles within the middle ear, such as the tensor tympani and stapedius muscles, can produce clicking, thumping, or fluttering sounds. Lifestyle factors like stress, anxiety, or high caffeine intake can also temporarily elevate blood pressure and heart rate, leading to a transient increase in the perception of pulsatile sounds.
Less Common, More Serious Conditions
While often benign, persistent pulsatile tinnitus can indicate more significant underlying medical conditions, particularly those affecting blood vessels. Atherosclerosis, where plaque builds up and hardens arteries, can narrow blood vessels in the head and neck. This narrowing creates turbulent blood flow, which may be heard as a distinct whooshing or thumping sound. Elevated blood pressure (hypertension) increases the force of blood against artery walls, making flow near the ear more audible.
Specific vascular malformations, such as arteriovenous malformations (AVMs), which are abnormal tangles connecting arteries and veins, can also cause turbulent blood flow perceived as a pulsing sound. Non-cancerous tumors near the ear, particularly highly vascular glomus tumors, can press on blood vessels or auditory structures. Increased intracranial pressure, as in Idiopathic Intracranial Hypertension (IIH), occurs when cerebrospinal fluid builds up around the brain, putting pressure on blood vessels. This elevated pressure can manifest as pulsatile tinnitus, often accompanied by headaches or visual disturbances.
Certain systemic conditions can also induce pulsatile tinnitus due to changes in blood volume or flow dynamics. Hyperthyroidism, an overactive thyroid gland, can increase heart rate and blood flow, making internal sounds more noticeable. Anemia, particularly iron-deficiency anemia, can cause the heart to pump harder to compensate for reduced oxygen-carrying capacity, leading to increased blood flow and audible pulsing. Temporomandibular joint (TMJ) disorders, affecting the jaw joint near the ear, can sometimes refer sounds or pressure to the ear, though this is less directly linked to the rhythmic pulsing of blood flow.
When to Seek Medical Attention and Treatment Options
Consulting a healthcare provider is advised if ear thumping is persistent, occurs in only one ear, or is accompanied by other symptoms like dizziness, hearing loss, headaches, or changes in vision. A medical evaluation helps rule out serious underlying conditions and ensures appropriate management.
The diagnostic process typically begins with a thorough medical history and physical examination, including an assessment of the head and neck. Imaging studies such as MRI, MRA (Magnetic Resonance Angiography), CT (Computed Tomography), or CTA (CT Angiography) may be performed to visualize blood vessels and structures near the ear and brain. Blood tests may also be conducted to check for conditions like anemia or thyroid dysfunction.
Treatment for pulsatile tinnitus is highly individualized and depends entirely on the identified underlying cause. This could involve medication to control high blood pressure or thyroid conditions, iron supplementation for anemia, or in some cases, surgical intervention for vascular malformations or tumors. When a specific cause cannot be found or if the sound persists after treatment, strategies like sound therapy using white noise generators or cognitive behavioral therapy (CBT) may help manage the perception and impact of the sound.