Pulsatile tinnitus is a rare form of tinnitus. People who have pulsatile tinnitus hear noise that may be loud or soft but often happens in time with their heartbeats. Like tinnitus, pulsatile tinnitus isn’t a condition. It’s a symptom of conditions such as heart disease or diseases that affect your veins and arteries.
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.
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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.
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.
Pulsatile tinnitus is a rare condition that accounts for about 10% of the estimated 50 million people who have tinnitus.
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.
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:
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:
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:
Pulsatile tinnitus happens when something changes your blood flow. You may not be able to prevent the underlying condition causing 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.
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.
Last reviewed by a Cleveland Clinic medical professional on 06/27/2022.
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