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, 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

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 usually has no identifiable cause, it’s more likely that there will be an underlying factor behind pulsatile tinnitus (though it may still prove difficult to pinpoint).

Many cases are caused by a change in the flow of blood through the vessels in and near your ear (around your head or neck), or a change in your awareness of this.

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

Frequently asked questions

Can pulsatile tinnitus be dangerous?

Pulsatile tinnitus itself is not usually dangerous, although for some sufferers, symptoms can prove annoying. A medical or hearing healthcare professional will advise on effective treatments for keeping these at bay.

It’s possible that your pulsatile tinnitus may be caused by an underlying health condition, so make sure you speak to your GP or a hearing health specialist as soon as you notice symptoms so they can carry out testing and give you any advice.

Does pulsatile tinnitus go away on its own?
Pulsatile tinnitus can disappear, but this will vary on a case-by-case basis and depend entirely on the underlying cause.

Common occurrences of pulsatile tinnitus, such as during exercise when blood pressure increases, tend to abate once the body regulates itself.
How can I stop pulsatile tinnitus?

Pulsatile tinnitus can sometimes be stopped completely by treating the underlying cause. For instance, sufferers of high blood pressure may find a low-sodium diet and regular exercise beneficial in curbing their symptoms.

But it’s always important to speak to your doctor to determine the best way of treating or managing your pulsatile tinnitus.

Is there a link between pulsatile tinnitus and anxiety?

Though there’s no evidence to say that tinnitus is caused by stress, it can make existing tinnitus worse. New research has suggested a link between anxiety and pulsatile tinnitus, particularly after a period of significant stress.

If this is the case, you may notice symptoms flare up while you’re under a lot of stress. Remember to take good care of your mental health as well as your physical wellbeing; it could go a long way in easing the impact of pulsatile tinnitus on your day-to-day life.

Is pulsatile tinnitus permanent?
Unless there’s an underlying cause that can be treated, or it has come on as a result of something like strenuous exercise, pulsatile tinnitus is usually permanent. It rarely goes away by itself, but this varies on a case-by-case basis.

However, there are ways to manage the condition, with many sufferers finding that sound therapy, relaxation therapy or Cognitive Behavioural Therapy (CBT) (among others) can help relieve their symptoms.
Can pulsatile tinnitus be cured?
Providing there’s an underlying cause to your pulsatile tinnitus, and treatment for that cause is effective, pulsatile tinnitus can be cured as the cause is cured.

There are instances where no cause can be found, and treatment then moves onto managing the condition, rather than curing it. There are many ways to do this, including Tinnitus Retraining Therapy (TRT), mindfulness and sound therapy.
Is pulsatile tinnitus hereditary?
Thanks to recent research, there’s evidence to suggest that some forms of tinnitus can run in families, and that you can be genetically predisposed to develop it. However, there’s still strong evidence that environmental factors play a part too.
Can pulsatile tinnitus be intermittent?
Yes. The noises associated with pulsatile tinnitus - such as throbbing, whistling, and ringing - aren’t always constant, and can come and go.

This is particularly the case if the condition is brought on by exercise as the symptoms should ease as your blood pressure returns to normal.

Pulsatile tinnitus is usually not a cause for concern; however, some cases can point to potentially serious health conditions, so it’s vital you get checked out by your GP or a trained audiologist as soon as possible.

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