Pulsatile tinnitus is a form of tinnitus that results in a person hearing whooshing, thumping, or throbbing in their ears. It can occur in one or both ears and often presents rhythmically with a person’s heartbeat. Pulsatile tinnitus can be mild only a minor annoyance, or it can be so intense that it becomes debilitating.
This article discusses the symptoms, causes, and treatment options for pulsatile tinnitus.
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Types of Pulsatile Tinnitus
The three types of pulsatile tinnitus, categorized by where the sound originates, are:
- Arterial: Arteries only
- Arteriovenous: Arteries and veins
- Venous: Veins only
The type is important because it helps narrow down where the issue stems from, assisting healthcare providers in diagnosing and treating the condition.
What Are the Symptoms of Pulsatile Tinnitus?
The main sign of pulsatile tinnitus is regularly hearing sounds, such as a beat. Other sounds can be:
- Buzzing
- Ringing
- Whistling
- Thumping
- Whooshing
Unlike other forms of tinnitus, the sounds in pulsatile tinnitus come from a physical source. For example, sounds can develop because of changes in blood flow in veins or arteries near the ear.
They can also develop because the normal flow of sounds from within the body is met with an increase in bone conduction. Bone conduction helps to transmit acoustic vibrations so that sounds can be heard.
The Pulsatile Tinnitus Rhythm Origin
The sound heard in pulsatile tinnitus comes from blood flow and is often in the same rhythm as the pulse. Essentially, people with this condition can hear their hearts beating from the inside.
What Causes Pulsatile Tinnitus?
Pulsatile tinnitus is often considered a symptom of vascular or other issues with vascular health, such as the structure or blood flow through veins and arteries. Possible causes include:
- Atherosclerosis: The hardening of plaque in the arteries resulting in blow flood interruptions
- Aneurysms: Ballooning in blood vessel walls
- Structural changes in the veins or arteries
- Fistulas (irregular connections) in the veins or arteries
- Tumors (abnormal masses) within blood vessels in the ear
- Head or neck tumors
- Capillary hyperemia: An increased amount of blood in the capillaries
- An increase in intracranial (skull) pressure
- Congenital (from birth) changes to the veins and arteries
- Transverse sinus stenosis: A narrowing of the two areas under the brain that allow blood to drain from the back of the head
- Paraganglioma: A type of tumor that forms near blood vessels and nerves by the adrenal glands
- Lesions in the vascular system: Clusters of blood vessel growth
- Anemia: Lack of healthy red blood cells
- High blood pressure (hypertension)
- Paget’s disease: A disease of the bone that disrupts normal bone remodeling (new bone tissue replacing old bone tissue)
- Sigmoid sinus diverticulum: Small pouches push through the sigmoid sinus wall into the mastoid bone that sits right behind the ear
- Bone loss in the temporal bone (a bone in the skull)
- Tumors of the temporal bone
- Inflammatory hyperemia: Extra blood flow and volume of blood
- Cholesterol granulomas: Benign (noncancerous) cysts in the temporal bone
- Perilymph fistula: A tear in the membrane that separates the inner and middle ear
- Hyperthyroidism (overactive thyroid)
- Conductive hearing loss: A blockage in the ear canal
- Head trauma (injury)
In as many as 30% of pulsatile tinnitus cases, no cause is found.
Is Pulsatile Tinnitus Serious?
Since many health disorders can cause pulsatile tinnitus, it can be either mild or dangerous. It highly depends on the cause; some are benign, while others can be life-threatening.
How Is Pulsatile Tinnitus Diagnosed?
Diagnosing pulsatile tinnitus involves collecting a health history and a list of symptoms. If a medical provider suspects pulsatile tinnitus, they will investigate the cause of the symptom. Some possible tests used to do this are:
- Magnetic resonance imaging (MRI) to closely examine the tissues in the neck and ears
- Magnetic resonance angiography (MRA) to check for issues within the blood vessels located in the head and neck
- Computed tomography (CT) or computed tomography angiography (CTA) to perform a scan using body-safe dye to highlight the problems within blood vessels and tissues
- Temporal bone CT scan to check for bone loss or abnormalities
- Ultrasound to examine tissue in the neck and ears
- Blood tests to check for thyroid function and anemia
In some cases, digital subtraction angiography (DSA) will be used. This is typically a last resort if other imaging tests do not provide enough information.
During the procedure, a small and thin tube known as a catheter will be placed into a leg artery and sent toward blood vessels in the brain. The dye that highlights issues within blood vessels goes through the catheter, and an X-ray takes a picture of the blood vessels.
Why Proper Diagnosis is Crucial
Pulsatile tinnitus can come before a stroke or bleeding in the brain. That is why it’s vital to get adequate testing at the first sign of symptoms.
New Device Could Provide Long-Term Relief from Tinnitus Symptoms
How Is Pulsatile Tinnitus Treated?
Treatment for pulsatile tinnitus begins with addressing the underlying cause. Because of that, treatments can vary widely. The good news is that once the underlying condition is treated effectively, pulsatile tinnitus symptoms will often go away completely.
Possible treatments can include:
- Lifestyle changes: Quitting smoking, losing excess weight, and engaging in regular exercise may be advised.
- Medications: To treat specific health disorders, such as anemia or hyperthyroidism, drugs will be prescribed.
- Surgery: If a structural problem or a tumor is causing the issue, surgery may be needed.
Treatment for No-Cause Pulsatile Tinnitus
In the event a cause isn’t found, healthcare providers will suggest other management techniques, such as:
- Sound therapy to help suppress the noises
- White noise machines or other wearable noise-suppressing devices
- Meditation and relaxation techniques
- Tinnitus retraining therapy to teach coping techniques
- Cognitive behavioral therapy, a common form of talk therapy
Natural Remedies for Tinnitus
Summary
Pulsatile tinnitus is a form of tinnitus that involves hearing whooshing, thumping, or buzzing in the ears that seem to be in rhythm with your heartbeat. The sounds can be mild and not affect your day-to-day life, but they can be debilitating in many cases.
Healthcare providers may conduct various imaging tests to help diagnose pulsatile tinnitus because there are many possible causes. Since a person experiencing the symptoms can be at risk for stroke or bleeding in the brain, it’s vital to get a proper diagnosis as soon as possible.
Healthcare providers will treat the underlying cause instead of the symptom unless there is no identifiable condition that causes it. In that case, you must manage your condition through various techniques, including sound therapy. If you experience pulsatile tinnitus, contact your healthcare provider immediately. It is curable; the faster you seek treatment, the better it will be for you.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Hofmann E, Behr R, Neumann-Haefelin T, Schwager K. Pulsatile tinnitus: Imaging and differential diagnosis. Dtsch Arztebl Int. 2013 Jun;110(26):451-8. doi:10.3238/arztebl.2013.0451
UCSF Department of Radiology and Biomedical Imaging. Pulsatile tinnitus causes and treatments.
Pegge SAH, Steens SCA, Kunst HPM, Meijer FJA. Pulsatile tinnitus: Differential diagnosis and radiological work-up. Curr Radiol Rep. 2017;5(1):5. doi:10.1007/s40134-017-0199-7
Penn Medicine. Pulsatile tinnitus.
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By Angelica Bottaro
Bottaro has a Bachelor of Science in Psychology and an Advanced Diploma in Journalism. She is based in Canada.
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