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What is pulsatile tinnitus?
Pulsatile tinnitus is a rare form of tinnitus. People who have tinnitus (pronounced “TIN-nite-us” or “TIN-e-tus”) may have constant noise in their heads that no one else hears. They often, but not always, describe it as a ringing sound. People who have pulsatile tinnitus hear noise that may be loud or soft but tends to happen in time with their heartbeats or may sound like a whooshing. Like non-pulsatile tinnitus, pulsatile tinnitus isn’t a condition. It’s a symptom of other disorders. Many times pulsatile tinnitus is a symptom of vascular disease — diseases affecting your veins and arteries — as well as malformations of vascular structures or atypical blood flow near your ear, and in some rare cases, tumors.
How does pulsatile tinnitus affect my body?
Like tinnitus, pulsatile tinnitus may interrupt your ability to concentrate, sleep or work. Some people who have tinnitus or pulsatile tinnitus develop depression or anxiety. Most importantly, pulsatile tinnitus may be a symptom — and your first warning — that you have a serious medical condition.
When should I be concerned about pulsatile tinnitus?
Any sudden unexplained change in your body is reason to contact your healthcare provider. Contact your provider right away if you suddenly hear a rhythmic swooshing sound in your head, hear that sound in one ear only or have other issues like difficulty walking, balance troubles or difficulty seeing.
Is pulsatile tinnitus a common problem?
Pulsatile tinnitus is a rare condition that accounts for about 10% of the estimated 50 million people who have tinnitus.
Symptoms and Causes
What are pulsatile tinnitus symptoms?
A rhythmic swooshing or whooshing noise inside of your head that often keeps pace with your pulse is the most common symptom of pulsatile tinnitus. This is commonly blood pulsing faster than normal through a variety of veins and arteries located near your ears. This may include large arteries or veins in your neck and at the base of your skulls, and smaller arteries in your ears. In a sense, people who have pulsatile tinnitus hear their hearts beating.
What causes pulsatile tinnitus?
In general, pulsatile tinnitus happens when certain conditions or abnormalities change the flow of blood in blood vessels near or around your ears. Sometimes, changing blood flow is a sign of a serious medical condition. Just having pulsatile tinnitus doesn’t mean you have these conditions.
In some cases, pulsatile tinnitus isn’t due to a change in the blood flow itself, but rather an enhanced ability to hear blood flow more intensely.
Here are some examples of conditions that may cause pulsatile tinnitus:
- Atherosclerosis: This is a hardening of your arteries, which can make for uneven blood flow. Just like quiet rivers that become a set of noisy rapids, uneven blood flow makes more noise than smooth-flowing blood through arteries close to your ear.
- Sinus wall abnormalities (SWAA): Your sinus wall is a channel on the side of your brain that receives blood from veins within your brain. Some people have conditions that cause increased blood flow that makes noise inside this channel, creating the whooshing sound associated with pulsatile tinnitus.
- Arteriovenous malformations: These are tangles of blood vessels affecting the connections between your veins and arteries. If you have arteriovenous malformation near your ears, you may develop pulsatile tinnitus.
- High blood pressure (hypertension): High blood pressure measures the pressure of blood against your blood vessel walls. If that pressure is too high, you may have high blood pressure that may cause pulsatile tinnitus.
- Anemia: Anemia may increase your blood flow, which may in turn affect your blood vessels and cause pulsatile tinnitus.
- Middle ear tumors: Some people have small tumors in their middle ears located near the parts of the ear that receive sound. These are glomus tumors with many blood vessels. Sometimes, people develop pulsatile tinnitus because they’re hearing blood flowing through glomus tumor blood vessels.
- Idiopathic intracranial hypertension: This happens when cerebrospinal fluid builds up around your brain, putting pressure on your blood vessels and possibly affecting blood flow.
- Head trauma: About 53% of people who have traumatic head injuries develop tinnitus, including pulsatile tinnitus.
- Hyperthyroidism: This condition may cause your heart to speed up, which in turn increases blood flow.
- Paget’s disease: Paget’s disease is a chronic bone disorder that may affect people’s skull. About 20% of people who have Paget’s disease develop hearing issues, including pulsatile tinnitus.
Diagnosis and Tests
How do healthcare providers diagnose pulsatile tinnitus?
Healthcare providers may start diagnosis by using a stethoscope — the same device they press to your chest to hear your heartbeat — to listen to your neck and skull. (When providers can hear sound that keeps pace with your pulse, they call it objective pulsatile tinnitus. If they don’t, it’s subjective pulsatile tinnitus.)
Regardless of the type of pulsatile tinnitus, providers will determine if the pulsatile tinnitus is happening in time with your heartbeat. They’ll also test your hearing. During the hearing test, they may use a special test called tympanometry to measure the pulsing in your ears to see if it aligns with your pulse.
Depending on your other symptoms, your provider may request different imaging tests. These tests let providers “see” what’s happening inside of your head and neck that may cause pulsatile tinnitus. Those tests may include:
- Angiography: This test uses contrast material and X-rays so providers can examine your blood vessels.
- Magnetic resonance angiography (MRA): This test checks for problems with blood vessels in your head and neck.
- Magnetic resonance imaging (MRI): An MRI uses a magnetic field and radio waves to produce cross-sectional images of particular structures or tissues within your body. Providers may use this test to obtain images of tissues within your ears and neck.
- Doppler ultrasound: Providers may use this test to see how blood is flowing through blood vessels in your neck.
- Computed tomography (CT) scan: This test uses X-rays and a computer to produce a 3D image of your head and neck.
- High resolution computed tomography (HRCT) scan: This test uses a narrow X-ray beam and advanced computer analysis to create highly detailed images of your blood vessels or other parts of your head and neck. Providers may use HRCT scans to look for sinus wall abnormalities (SWAA).
Management and Treatment
How do healthcare providers treat pulsatile tinnitus?
Healthcare providers treat pulsatile tinnitus by identifying and treating the underlying condition. For example, if you have pulsatile tinnitus because you have atherosclerosis, your provider may use medication to manage your condition. The medication may eliminate or reduce the swooshing sound of your heart beating in your ear.
Sometimes, tests rule out all possible medical conditions. In that case, your provider can still manage pulsatile tinnitus. Here are some possible interventions:
- Sound generators: These devices produce and deliver sounds to your ears that mask tinnitus and pulsatile tinnitus. For example, the sound generator may deliver soothing sounds like a shower or quiet rain. Some people may benefit by using hearing aids that include sound generators.
- Environmental enrichment devices: You can create your own way of masking tinnitus and pulsatile tinnitus. Tabletop sound machines that generate soothing background noise, recordings of music, nature or other sounds or apps for smartphones and tablets can make tinnitus less noticeable.
- Relaxation techniques: You may feel stressed out or frustrated by the incessant sound of your heartbeat. Learning techniques to increase relaxation and ease stress can help people better deal with that frustrations and stress.
- Counseling options: Some people benefit from mental wellness therapies like cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). These therapies help people learn how to pay less attention to the noise in their heads.
Can I prevent pulsatile tinnitus?
Pulsatile tinnitus happens when something changes your blood flow. You may not be able to prevent the underlying condition causing pulsatile tinnitus.
Outlook / Prognosis
What can I expect if I have pulsatile tinnitus?
Pulsatile tinnitus may be a symptom of any number of underlying medical conditions. If your healthcare provider is treating a specific condition, you may want to ask them if treating your condition will eliminate or reduce pulsatile tinnitus.
I have pulsatile tinnitus. How do I take care of myself?
The best self-care for pulsatile tinnitus is to talk to your healthcare provider. If they can find and treat the underlying cause, they may be able to eliminate the sounds from pulsatile tinnitus.
A note from Cleveland Clinic
Pulsatile tinnitus is a rare issue. Like tinnitus, pulsatile tinnitus can affect your quality of life, keeping you awake when you want to rest or distracting you when you need to concentrate. The difference is tinnitus makes constant random noise. Pulsatile tinnitus is like a real-time soundtrack of your blood flowing to and from your heart. Annoying as it may be, that soundtrack may save your life. Pulsatile tinnitus may be the first sign you have a serious medical condition that affects your blood flow. Talk to your healthcare provider if you notice noise in your ears that keeps time with your pulse. They’ll find out if there’s an underlying and potentially serious problem and take steps to treat it.
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