Pulsatile tinnitus: causes & treatment

What is pulsatile tinnitus?

Pulsatile tinnitus is a rare condition, brought on by constricted blood flow in and around the ears. While tinnitus consists of seemingly random hissing, whooshing, rushing or roaring sounds, with pulsatile tinnitus, the sounds come in time to the rhythm of your own heartbeat.

Most people experience pulsatile tinnitus in just one ear, but it can occur in both. And while pulsatile tinnitus usually isn’t anything to worry about, the condition may be a sign of an underlying health complication – so speak to your GP if you’re not sure what’s causing your symptoms.

Here, we’ll look at some of the most important information about pulsatile tinnitus.

Pulsatile tinnitus symptoms

Though the sounds associated with both forms of tinnitus can vary from person to person, the main symptom of the pulsatile form of this condition is ringing in one or both ears. You may also hear noises that can be described as:

• Whooshing

• Grinding

• Hissing

• Whistling

• Thudding

These aren’t the only sounds you can experience with pulsatile tinnitus. You may also hear a thumping or throbbing sound that beats in time with your heartbeat (an effect of the blood circulating around your body).

Pulsatile tinnitus causes

While standard tinnitus often lacks a clear cause, pulsatile tinnitus tends to have identifiable factors, though pinpointing them can be challenging. This condition is often linked to changes in blood flow through vessels near the ear, typically occurring unilaterally (in one ear).

This change can happen for a number of reasons, including:

• An increase in the blood flow around your body - This can happen as a result of pregnancy, exercise, some medications or anaemia (a severe iron deficiency).

• Irregularly shaped blood vessels - Blood vessels with irregular shapes can encourage your blood to flow vfaster, which makes more noise than slow-flowing blood.

• Artery blockages - Atherosclerosis is a condition that causes fatty deposits to clog up your arteries, meaning your blood will not be able to easily flow through them.

Your awareness of the blood flowing in and around your ears can be caused by conditions that can block your ears, meaning your internal sounds are amplified. These include a perforated eardrum and impacted earwax.

Other common causes of pulsatile tinnitus include:

• High blood pressure

• Hyperthyroidism – when the thyroid gland is overactive

• Blockage in your arteries

• Altered awareness – brought on by factors such as conductive hearing loss

• Head or neck tumours

You may also have symptoms of pulsatile tinnitus if you suffer from a condition that leads to increased pressure in your head (characterised by headaches and problems with your eyesight, as well as pulsatile tinnitus).

If you do notice any signs that could indicate pulsatile tinnitus, speak to your doctor as soon as possible so they can examine you and confirm the diagnosis.

Pulsatile tinnitus diagnosis

It’s important that any symptoms are assessed by your GP.

They’ll carry out an initial review of your symptoms and medical history, including finding out about any other symptoms you may have, and will examine your ears and neck to check how well your blood is circulating.

They may also arrange additional tests to determine the exact nature of your condition. These may include:

• A hearing check

• Blood test

• MRI

• CT scan

• Angiogram (to review how well your blood vessels are functioning)

• Ultrasound

If your doctor can detect pulsatile tinnitus with just a stethoscope on your neck or skull, you’ll be diagnosed as having objective pulsatile tinnitus. If not, it’ll be classified as subjective pulsatile tinnitus.

Your doctor or hearing healthcare professional may refer you to an ear, nose and throat (ENT) specialist to investigate potential causes.

Pulsatile tinnitus treatment

For most cases of pulsatile tinnitus, treatment comes by addressing the underlying cause.

For instance, if it’s brought on by high blood pressure or a condition involving a vein or artery, pulsatile tinnitus can be treated with a combination of medication and lifestyle changes. These can include:

• Regular exercise

• Quitting smoking

• Reducing stress

• Switching to a low-sodium diet

Some underlying causes may require medication or surgery to resolve, but your doctor and ENT specialist will be able to advise you on the most suitable course of action.

Where there isn’t an underlying cause (or one that can’t be identified), pulsatile tinnitus treatment involves managing the condition, and this means training your brain to ignore tinnitus sounds. By doing this, you can limit its impact on your day-to-day life. Options include:

• Sound therapy

• Cognitive Behavioural Therapy (CBT)

• Tinnitus Retraining Therapy (TRT)

• Relaxation exercises

• Mindfulness techniques

• Counselling