What Is Pulsatile Tinnitus?
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.
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:
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 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.
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.
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.
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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.
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
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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.