What is pulsatile tinnitus?
Tinnitus is described as the perception of a sound without an external source. This is commonly heard as a buzzing, hissing or ringing in the ears.
Less commonly, people report that their tinnitus sounds like their heart beating in ear, or a pulsing in ear, which is called pulsatile tinnitus.
Do I have pulsatile tinnitus?
An easy way to check if you have pulsatile tinnitus is to feel the pulse in your wrist whilst listening to the sound of your tinnitus to see if they match.
Why do I hear pulsing in my ear?
The sound of pulsatile tinnitus is usually thought to be related to:
- an increase in the amount of blood flowing around the ears
- an increase in the person’s awareness of this, often because the blood flow is turbulent and therefore noisier
- because the bone separating the ear from flowing blood has become thinner.
Tinnitus can be divided into subjective tinnitus (which is only heard by the person themselves) and objective tinnitus (can be heard by others as well).
Pulsatile tinnitus can fall into either of these two categories.
What causes pulsatile tinnitus?
Much like conventional or classical tinnitus there are many potential causes of tinnitus and it is often not easy to find the underlying cause. Most common causes are systemic (i.e. arising from changes in a body system) but others can be uncommon or rare.
There are a large number of systemic conditions that can cause pulsatile tinnitus. These include physiological states in which blood flow is increased, such as:
- high blood pressure
- physical exercise
As well as conditions where the heart pumps more vigorously, such as in:
- anaemia (not enough haemoglobin or red blood cells in the blood and therefore reduced transport of oxygen to the rest of the body)
- hyperthyroidism (overactive thyroid gland)
Changes in Blood Flow Close to the Ear
All of us have blood flowing through the blood vessels of the head and neck, but we’re not normally aware of the sound of this.
If the bony barriers between the blood vessels and the ear are thinned, then the sound can be transmitted more easily and picked up by the ear. This happens in a condition called Benign Intracranial Hypertension.
Benign Intracranial Hypertension
This condition is usually thought of as affecting overweight young and middle-aged women, though it can occur in people of any age and gender.
Here, a higher pressure of the fluid inside the head leads to pressure on the thin sheets of bone between the brain and the ear, causing the bone to become thin and in some cases for tiny holes to appear.
Similar sound transmission can occur if the passage of blood through the sigmoid sinus (a large vein that travels very close to the ear) is turbulent, either because of a diverticulum (a bit that sticks out) or because the bony wall of the sinus is rough or too thin.
Other rare causes
The stapedial artery is a blood vessel that supplies blood to the ear during development, but has normally disappeared by the time we are born.
Paragangliomas are rare benign tumours, which typically have a rich blood supply running inside or close to the ear.
Sometimes, pulsatile tinnitus can occur due to increased turbulence of blood vessels in the neck, such as the carotid artery.
As we become older, deposits of cholesterol can build up in the blood vessels in a process called atheroma formation. As blood is forced through these narrowings it becomes turbulent, much like water going through rapids or a waterfall.
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Increased Awareness of Blood Flow
People can become more aware of blood flowing close to the ear either due to:
- reduced sound getting to the ear from the outside world, as happens in some types of hearing loss, such as glue ear or
- due to increased sensitivity of the auditory pathways taking sound from the ear to the brain, as happens in conventional tinnitus. This may be the initial result of injury or dysfunction of almost any part of the hearing system but is thought to continue due to the central parts of the auditory pathway, and not just the initial damage.
What tinnitus tests are available for pulsatile tinnitus?
If you have can hear pulsing in ear or your heart beat in your ear you should see a doctor to get professional help with your tinnitus.
Whilst often no cause can be identified, some causes can be treated and if left undiagnosed may cause you long term health problems.
Physical examination usually includes hearing tests as well as listening to the neck and the area around the ear to see if blood flow is turbulent or can be heard in abnormal places.
Blood tests can be used to identify anaemia or an overactive thyroid gland. Scans can be helpful to look for other anatomical causes, such as narrowings of blood vessels, benign tumours, abnormal bone thickness or smoothness and other conditions.
The type of scan, or scans, chosen varies between healthcare providers but may include Magnetic Resonance Imaging (MRI), Computed Tomography(CT) or Ultrasound. Sometimes special types of MRI or CT, known as MR or CT angiography, are used.
What treatments are available for pulsatile tinnitus?
The treatment options for pulsatile tinnitus vary depending on whether a cause has been identified.
Systemic causes of pulsatile tinnitus can often be treated, for example if high blood pressure is discovered tablets can be used to reduce this.
An overactive thyroid gland can be treated with tablets in most patients and sometimes surgery if tablets are not controlling it well enough.
If anaemia is discovered, the cause of this should be looked into.
In women of childbearing age this is commonly due to blood loss from menstruation and is more common in people of any gender due to iron deficiency. This is often caused by a lack of iron in your diet, for example in people with a vegetarian diet without sufficient green leafy vegetables or vitamin supplements.
Some local causes can also be treated, though this often involves surgery.
Often people find that just knowing what the cause is, and that it isn’t anything to worry about, is enough and they do not then want to have surgery. Surgical treatment for pulsatile tinnitus is not very common and the results are not easy to predict.
As with other types of tinnitus, much depends on how troublesome it is.
It can be frustrating to discover that there is no quick fix or immediate cure to your tinnitus but it's important to remember that there are way of managing it in the long run and a number of treatment options to try.
The Oto app offers techniques to reduce tinnitus intrusion such as:
- CBT techniques
- Sound enrichment and audio landscapes
- Mindfulness activities
- Exercises to promote relaxation and physical wellbeing including shoulder, neck, and jaw stretches
Check out Oto's Tinnitus Support Group, a supportive community for individuals with tinnitus or related conditions to receive regular tips and tricks from the expert team at Oto!