Pulsatile Tinnitus

Pulsatile tinnitus is a type of tinnitus where a person hears a rhythmic noise that matches their heartbeat, often described as a whooshing sound. Unlike regular tinnitus, which can manifest as a constant ringing or buzzing, pulsatile tinnitus is typically related to issues with blood vessels or blood flow near the ear.

It is not a disease on its own, but often a symptom of an underlying condition, so diagnosis is critical. To determine the cause and receive proper treatment for pulsatile tinnitus, our North Carolina Neuroscience & Spine Center neurologists and neurosurgeons can help.

Possible Causes of Pulsatile Tinnitus

This condition is often caused by accelerated blood flow through veins and arteries near the ears. While it can be due to various underlying issues affecting blood flow, it may also occur simply because of increased sensitivity to the sound of normal blood circulation.

Here are some examples of conditions that may contribute to the development of pulsatile tinnitus:

Atherosclerosis

This condition involves the hardening of arteries, resulting in uneven blood flow. Like a tranquil river transforming into turbulent rapids, uneven blood flow generates more audible noise compared to smooth circulation in the arteries near the ear.

Sinus Wall Abnormalities

The sinus wall acts as a channel on the side of the brain, receiving blood from intracranial veins. Some individuals may have conditions that lead to heightened blood flow within this channel, causing audible whooshing sounds associated with pulsatile tinnitus.

Arteriovenous Malformations

These are clusters of blood vessels affecting the connections between veins and arteries. Pulsatile tinnitus can develop when arteriovenous malformations occur near the ears.

High Blood Pressure (Hypertension)

Elevated blood pressure levels result in increased force against the blood vessel walls. Excessive pressure may lead to pulsatile tinnitus.

Anemia

Anemia can elevate blood flow, potentially affecting blood vessels and causing pulsatile tinnitus.

Middle Ear Tumors

Glomus tumors, characterized by numerous blood vessels, can develop near the parts of the ear responsible for sound reception. Sometimes, people experience pulsatile tinnitus as they hear blood flowing through the blood vessels within these tumors.

Idiopathic Intracranial Hypertension

This condition arises when cerebrospinal fluid accumulates around the brain, exerting pressure on blood vessels and potentially influencing blood flow.

Head Trauma

Approximately 53% of individuals who sustain traumatic head injuries may develop tinnitus, including the pulsatile variant.

Hyperthyroidism

An overactive thyroid gland can accelerate the heart rate, leading to increased blood flow, which may cause pulsatile tinnitus.

Paget’s Disease

This chronic bone disorder can affect the skull, with around 20% of these patients developing hearing issues, including pulsatile tinnitus.

Request Appointment

Diagnosing Pulsatile Tinnitus

During your first appointment at the North Carolina Neuroscience & Spine Center, one of our providers will first attempt to diagnose pulsatile tinnitus by using a stethoscope to listen for sounds in the neck and skull that sync with the patient’s pulse. If these sounds are audible to the doctor, the condition is classified as objective pulsatile tinnitus; if not, it is considered subjective.

Regardless of type, your neurologist will check if the sounds match the heartbeat and may perform hearing tests, including tympanometry, to assess the condition further. Based on your symptoms, they may also order imaging studies, such as:

Angiography
Magnetic Resonance Angiography (MRA)
Magnetic Resonance Imaging (MRI)
Doppler Ultrasound
Computed Tomography (CT) Scan
High-Resolution Computed Tomography (HRCT) Scan

How Pulsatile Tinnitus is Treated

Healthcare providers approach the treatment of pulsatile tinnitus by treating the underlying medical condition. Examples of treatments for each of the conditions mentioned above include the following:

Atherosclerosis: Medications and lifestyle changes would be used to improve cardiovascular health.
Sinus wall abnormalities: Interventional surgery could be an option in these instances.
Arteriovenous malformations: Surgical correction (or sometimes a catheter or radiation) would be performed to repair abnormal vessels.
High blood pressure (hypertension): Medications and lifestyle modifications would be implemented to control blood pressure.
Anemia: Iron supplements or medications would be prescribed to increase red blood cell count.
Middle ear tumors: Surgery, radiation, or chemotherapy would be required to remove the tumor if it is malignant or causing significant pulsatile tinnitus and/or other issues.
Idiopathic intracranial hypertension: Medications or surgical interventions could be used to reduce cerebrospinal fluid pressure. In less severe cases, lowering your BMI could help relieve symptoms.
Head trauma: Treatment would depend on the severity and type of injury.
Hyperthyroidism: Medications, radioiodine therapy, beta-blockers, or surgery would be used to regulate thyroid function.
Paget’s disease: Osteoporosis medications might be given to manage bone remodeling.

How Much Do Pulsatile Tinnitus Treatments Cost?

The cost of treating pulsatile tinnitus can vary significantly based on the recommended treatment option(s) and the severity of your condition. In addition, the price of care can also be affected by your insurance coverage.

FAQs About Pulsatile Tinnitus

Can stress or anxiety worsen pulsatile tinnitus?

Yes, stress and anxiety can often worsen the perception of pulsatile tinnitus. Emotional or physical stress can elevate blood pressure and increase sensitivity to internal sounds, making the condition more noticeable.

Can pulsatile tinnitus go away on its own?

In some cases, pulsatile tinnitus may resolve on its own, especially if it is related to temporary conditions like an ear infection or stress. However, persistent pulsatile tinnitus usually requires a medical evaluation to determine and address the underlying cause.

Can wearing earplugs help with pulsatile tinnitus?

Wearing earplugs typically does not help with pulsatile tinnitus and may actually make the condition more noticeable. Since the noise comes from internal blood flow, blocking external sounds with earplugs can sometimes increase awareness of the pulsatile sound.

Contact Us for More Details

If you or your primary care physician suspect pulsatile tinnitus, our North Carolina Neuroscience & Spine Center neurologists and neurosurgeons may be able to help. Contact us today to schedule an appointment at one of our offices in Raleigh, Clayton, Holly Springs, Wakefield, or Cary, NC.