If you have a thumping or whooshing sound in one or both ears that seems to follow a steady beat, you may have this rare form of tinnitus. Like regular tinnitus, you hear a constant sound that others don’t. But with the pulsatile form, the noise comes from inside your body. Your doctor may also be able to hear it if they listen with a stethoscope. It’s also called rhythmic, vascular, or pulse-synchronous tinnitus.
Symptoms
The telltale sign of pulsatile tinnitus is the steady whooshing sound you hear that beats in time with your heart. It may affect one or both ears, come and go, or worsen when you exercise, lie down, or are stressed.
Get to an ER right away if you have any of the following symptoms:
- Hearing loss
- Ear pain or drainage
- Severe dizziness
- Speech problems
Can you have pulsatile tinnitus in one ear only?
Yes. Pulsatile tinnitus can affect one or both ears. It may be barely noticeable or extremely distracting and can even affect your quality of life.
What Causes Pulsatile Tinnitus?
Pulsatile tinnitus is a symptom of an underlying medical issue. What’s the most common cause of pulsatile tinnitus? Most often, it’s due to a change in how blood flows through arteries and blood vessels near the ear. This change can be caused by any of the following:
Irregular blood vessels
This is a common issue. When blood flows through damaged or kinked vessels in the brain near or around the ear, it can change pressure and noise. A narrow or kinked neck artery (the carotid artery) or vein (the jugular vein) can also cause the sound.
High blood pressure
This can lead to a change in blood flow. Things such as stress, alcohol, and caffeine can all raise blood pressure, making the noise more noticeable.
Atherosclerosis
This is a hardening of your arteries. As cholesterol and other fats clog your blood vessels, they grow less flexible. That makes blood flowing near your middle and inner ear move with more force, such as water through a narrowed stream. You’ll usually hear it in both ears.
An overactive thyroid
A study of a large population over 10 years shows that people who had hyperthyroidism were more likely to have tinnitus.
Idiopathic intracranial hypertension
This happens when fluid surrounding the brain and spinal cord builds up, increasing pressure around the brain. In addition to pulsatile tinnitus, you might experience:
- Headaches
- Dizziness
- Vision problems
- Hearing loss
Sinus wall abnormalities
Small pouches or weak spaces in the sinus wall make it easier to hear blood flowing through blood vessels near the ear.
Connection between arteries and veins
A condition called arteriovenous malformation generally affects only one ear.
How Do I Know if I Have Pulsatile Tinnitus?
“The work-up of pulsatile tinnitus often involves imaging, audiometry (hearing testing), and specialty evaluation with an ENT physician,” says Jack Shohet, MD, a double board-certified neurotologist and otolaryngologist in Newport Beach, California, who regularly treats patients with this condition.
Your doctor will do a thorough physical exam to understand when your symptoms began and how long you have had them. They’ll do a hearing test to check for hearing loss and vertigo. They may also do a head and neck exam, as well as a cardiac exam to check for heart valve disease.
Other tests might include:
How Is Pulsatile Tinnitus Treated?
Your treatment plan depends on what’s causing it. Typically, once doctors treat the condition responsible for your pulsatile tinnitus, the whooshing sound stops. For example, if a damaged blood vessel is causing the sound, you may need medication or surgery to repair it.
“A cause is identified in almost 70% of cases, and many of these can be treated,” Shohet says.
Depending on the cause of your pulsatile tinnitus, treatment might include:
Medications. Your doctor may prescribe medicine to treat high blood pressure, anemia, or thyroid issues if they’re causing your pulsatile tinnitus.
Lifestyle changes. Eating a healthy diet and losing excess weight may stop pulsatile tinnitus caused by idiopathic intracranial hypertension (IIH).
Stenting. If your condition is caused by IIH or a narrowing of the veins in your brain, your doctor might suggest stenting. This is a minimally invasive procedure where they’ll use a stent to widen the vein, restoring blood flow and stopping pulsatile tinnitus symptoms.
Surgery. This is the standard treatment if your pulsatile tinnitus is caused by a tumor.
In rare cases, your doctor may not be able to find what’s causing your pulsatile tinnitus. Many times, Shohet says, the condition will eventually go away on its own. But if it’s affecting your quality of life, these alternative treatments might help:
White noise. It can help make the sound less noticeable, especially at bedtime. You can get a white noise machine or see if an air conditioner or fan in your bedroom helps. Some smartphone apps make white noise, too.
Wearable sound generators. These masking devices look like hearing aids. They create a constant, low-level background noise.
Tinnitus retraining. You wear a device that plays music at a certain frequency that helps you tune out the tinnitus.
Cognitive behavioral training (CBT). This type of therapy helps you manage how you respond to pulsatile tinnitus and can help reduce feelings of anxiety or depression caused by the condition.
If none of these options help, consider getting a second opinion or asking your doctor to refer you to another specialist, such as an interventional neuroradiologist or a vascular neurologist.
Takeaways
Pulsatile tinnitus — a whooshing or thumping sound in one or both ears that beats in sync with your heart — is a rare form of tinnitus. It’s usually caused by blood flow issues near your ears. In most cases, pulsatile tinnitus resolves when doctors treat the condition causing it. This may include medications, lifestyle changes, minimally invasive procedures like stenting, or surgery.
Pulsatile Tinnitus FAQs
What is pulsatile tinnitus, and how does it differ from regular tinnitus?
Pulsatile tinnitus is a whooshing sound in one or both ears that mirrors your heartbeat. Most of the time, it’s caused by problems with the blood vessels (vascular system) in your head and neck. The whooshing sound may come and go, or be worse when you exercise or lie down. Regular tinnitus is a constant, high-pitched ringing or buzzing sound in one or both ears.
What common health conditions can cause pulsatile tinnitus in older adults?
Some of the most common causes of pulsatile tinnitus in the elderly include plaque buildup in the arteries (atherosclerosis), narrowing of the blood vessels in the head and neck (vascular stenosis), high blood pressure, and diabetes.
What treatment options are available if an underlying cause is found?
If pulsatile tinnitus is caused by an underlying health condition, it normally goes away once that health condition is treated. Depending on the cause, your doctor may recommend medications, lifestyle changes, surgery, or other procedures, such as stenting, to widen narrow veins.
What can someone do if the cause of pulsatile tinnitus isn’t identified?
In many cases where doctors can’t find the cause of pulsatile tinnitus, it eventually goes away on its own. In the meantime, a white noise machine or wearable masking device may help reduce the sound. Alternative techniques, such as cognitive behavioral therapy (CBT), can help boost your mood and change how you respond to living with pulsatile tinnitus.
