What is Pulsatile Tinnitus?

First, what is tinnitus? This occurs when someone hears a sound in their ears without any particular outside trigger. The sounds may be described as ringing, buzzing or whistling. The presence of sound can be mild or severe, and can be temporary or permanent. Tinnitus is considered a symptom, rather than a disease itself. It can occur in one or both of the ears.

Pulsatile Tinnitus

Pulsatile tinnitus (PT) is one form of tinnitus. The sounds someone will hear with this are more rhythmic or flowing. They may be throbbing, beating, whooshing or thumping. This is because the sounds are usually in sync with the person’s heartbeat (Penn Medicine, 2021). If their pulse increases, so can the sound; if their pulse slows down, so will the sounds. 

The sound has also been described as low-pitched, like someone walking in snow, or high-pitched, like a bird screeching. Some patients report PT as just annoying, while others may find it disruptive to life. It may be difficult to concentrate, relax or sleep. The noises may be louder at night time when you are quiet. 

Causes of Pulsatile Tinnitus

The source of PT can be found by medical examination, obtaining history and performing imaging. It can be caused by dysfunction of the arteries and veins of the head and neck. The sounds come from a change in blood flow; you can actually hear it flowing abnormally. An increase in blood flow means it is moving more quickly and will make more noise. 

What Changes Blood Flow?

Blood pressure can be disturbed by a variety of factors. Generalized increased blood flow means there is an increase in the speed of blood flow within the whole body. This can arise from strenuous exercise, pregnancy, anemia or hyperthyroidism. Localized increased blood pressure means the speed is increased in a single blood vessel or a group of vessels, often near the ear. This can arise from a tumor, atherosclerosis, head trauma or fetal abnormality (Cubex, 2021). 

Other Causes for Pulsatile Tinnitus

Other factors can increase your awareness of blood flow sounds within the blood vessels. Conductive hearing loss, which can be caused by a ruptured eardrum, can make you more aware of bodily sounds. If you cannot hear “outside” noise very well anymore, you may have a heightened sense of “inside” noise. A buildup of fluid in the middle ear can be caused by an ear infection, inflammation or Eustachian tube dysfunction. This can lead to PT. If you have a neurological condition, you may hear noise more intensely than other people do. You may be more sensitive to your internal auditory stimuli (blood flow). 

Evaluation

Pulsatile tinnitus occurs in a small percentage of the population, and it is often treated successfully. You should seek an evaluation if you experience PT, as with any new changes in health. You can visit your primary physician, a neurologist or an otolaryngologist (ear, nose, and throat specialist).

The pulsing sounds can actually be heard by the doctor, which helps with diagnosis. There will be something physical making the sound, rather than just an imagined noise in the ear. If the doctor cannot locate the sounds, you may still have PT and treated for it. 

Imaging that may be performed to diagnose PT includes ultrasound, angiography, computerized tomographic angiography, computerized tomography scan, magnetic resonance angiography, magnetic resonance imaging and temporal bone CT scan.

Pulsatile tinnitus could be a sign of an underlying serious condition. It is often directly related to the vascular system, and the origins can be either benign or dangerous.

Classification 

According to a 2013 study, the causes of PT are classified by the site of origin: Arterial, arteriovenous or venous. An arterial cause would be atherosclerosis. Arteriovenous causes include skull base tumors. Venous origins include intracranial hypertension. The same study reports that no origin was found in up to 30% of PT patients, even after examination. 

Treatment for Pulsatile Tinnitus

Pulsatile tinnitus is typically treated with three different methods: Medications, surgery and self-management techniques. The method will depend on what type of underlying condition you have that is causing the PT. 

If you have high blood pressure (hypertension) that is causing increased force of blood flow, you may be prescribed medications to lower your blood pressure. You might also be advised to exercise, lose weight and quit smoking tobacco. Blood tests may help to find anemia or a thyroid problem. Medications can then be given for these conditions.

Surgery can help correct a physical problem, like an aneurysm. Venous sinus stenting has shown good results as a minimally invasive procedure. A stent is inserted in the narrow part of the affected vein, which opens up the space and restores proper blood flow. This can decrease or stop the PT symptoms. Surgery could also be used to remove a head or neck tumor. 

If the PT is caused by a hearing loss, you will have to treat that specific ear problem. You may need a hearing aid, need ear wax removed or need to treat an ear infection.

Self-management techniques are meant to help you cope with the PT and still carry out your daily routine. They can reduce the sound symptoms, or simply help you manage living with them. You may use sound therapy, a noise-suppressing device, cognitive behavioral therapy or meditation (Penn Medicine, 2021). To drown out the PT whooshing sounds, you can use a fan, air conditioner, white noise machine or a wearable sound generator. 

If you are hearing extra sounds in the ear, you should be seen by your doctor to find the cause. If you have pulsatile tinnitus, there is still hope for a healthy future. Many people undergo treatment for the symptoms, and many more can learn to live with the sounds. Reading professional sources and speaking with your healthcare team can help guide your hearing journey. 

Hofmann, E., Behr, R., Neumann-Haefelin, T., & Schwager, K. (2013). Pulsatile Tinnitus: Imaging and Differential Diagnosis. Deutsches Arzteblatt International, 110(26), 451–458. 10.3238/arztebl.2013.0451 

Weill Cornell 

Pulsatile Tinnitus | Weill Cornell Brain and Spine Center

Penn Medicine 

Pulsatile Tinnitus – Symptoms and Causes (pennmedicine.org)

Northwestern Medicine  

Northwestern Medicine Pulsatile Tinnitus Clinic | Northwestern Medicine 

Cubex

Pulsatile Tinnitus : Causes and Treatments | Cubex Audiologists – London

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