What is pulsatile tinnitus? Why you should seek immediate treatment

Tinnitus is a common condition which affects around 10 to 25% of adults. However, there are different types of tinnitus and certain criteria which means it’s important to get it investigated immediately – all of these criteria will be covered in this article.

So, what exactly is tinnitus?

Simply put, tinnitus is technically any sound that you hear in your ears or your head which is not being produced by an external sound source. In fact, it’s different for everybody.

In a recent poll that I put out on my YouTube channel asking about personal experiences with tinnitus, there was a mixed bag of descriptions which included pulsatile, tonal, roaring, electric buzzing, and ringing, to boiling kettle static sounds, warble sounds, and even the sound of people chanting in the forest.

I personally suffer from a high-pitched, continual tinnitus, which sounds something like this: it’s there 24/7, and I notice it the most if I’m lying in bed in the evening, or if I’m tired, stressed, or unwell. It gives me great solace to know that tinnitus is unbelievably common, with around 50 million people experiencing some form of tinnitus, and more often than not, it’s nothing that you need to worry about.

Tinnitus that requires a doctor

There are, however, certain characteristics with any of the tinnitus sounds that I’ve just mentioned that do require an immediate medical opinion.

For example:

  • If your tinnitus is only in one ear
  • If it’s changed in nature over a very short period of time
  • If it stops you from sleeping or
  • If it contributes to you experiencing anxiety or depression

But saying all of that doesn’t cover the subject of today’s topic, and the big question is: why is the type of tinnitus that I’m talking about today any different whatsoever? And why is it a little bit more serious than all of those that I’ve just listed above?

Firstly, it’s not as common. Research shows that pulsatile tinnitus affects around 5 million Americans, and to add to that, it isn’t just annoying like a lot of the other tinnitus we’ve discussed. However, it could potentially be a sign of an underlying health issue – hence my recommendation for immediate investigation.

tinnitus sounds

Pulsatile tinnitus sound

If your tinnitus sounds a little like a heartbeat, swishing or whooshing, it’s likely that you’re experiencing a form of pulsatile tinnitus. As I mentioned earlier, it’s a bit different and potentially more serious than any other form of tinnitus.

Instead of a continuous noise, you’ll hear a rhythmic sound that can match your heartbeat, and unlike other forms of tinnitus, which are often a continual tone, pulsatile tinnitus beats in sync with your pulse.

What causes pulsatile tinnitus?

There are several causes of pulsatile tinnitus, some being benign and others which are a little more serious.

Atherosclerosis

This condition occurs when plaque, which is made up of fat, cholesterol, and other substances, builds up inside your arteries. Over time, this plaque hardens and causes narrowing, restricting blood flow. If this happens in the arteries near your ears, the turbulent blood flow can create a rhythmic sound that matches your heartbeat, which you may perceive as pulsatile tinnitus.

Blood vessel disorders

Certain blood vessel disorders can also lead to pulsatile tinnitus, with conditions such as aneurysms and arteriovenous malformations being key examples of this. An aneurysm is a bulge in the wall of an artery, often due to weaknesses in the arterial wall.

Again, if this occurs near your ear, it can cause turbulent blood flow, leading to pulsatile tinnitus. Slightly differently, arteriovenous malformations are abnormal connections between the arteries and the veins, bypassing the capillary system. Again, if this happens, it can cause direct high-pressure blood flow from your arteries to your veins, creating this pulsatile sensation.

High blood pressure

Another cause for pulsatile tinnitus is high blood pressure, also known as hypertension, which can result in an increase in blood flow force through your arteries, especially near your ear. Again, this turbulent flow can create a rhythmic sound in sync with your heartbeat, perceived as a thumping or whooshing noise.

high blood pressure

Ear abnormalities

Ear abnormalities such as superior semicircular canal dehiscence syndrome which occurs when part of the bone near your semicircular canals in your inner ear is abnormally thin or missing, can also be a risk factor for pulsatile tinnitus.

In around 1 to 2% of individuals, this bone doesn’t mature and thicken properly and, in fact, can even become thinner with age. This is often accompanied by sufferers excessively hearing their own voice, and their footsteps, and it’s even reported that some sufferers can hear their own eye movements.

Tumours

Another cause of pulsatile tinnitus could potentially be a tumour, such as a glomus tumour, in your head or neck. These highly vascular tumours compress nearby blood vessels, disrupting normal blood flow and creating a rhythmic sound, which you may perceive as pulsatile tinnitus.

Glomus jugular tumours, for example, can grow near the jugular vein and into your middle ear, causing this kind of tinnitus, which is sometimes accompanied by hearing loss too.

Myoclonus

As well as the conditions that can cause pulsatile tinnitus, there are also types of rhythmical tinnitus. For example, myoclonus is a condition that involves the rhythmic contraction of muscles within your middle ear, which can sometimes contract involuntarily. It’s a little bit like that strange feeling that you get when your eyelid twitches—we’ve all experienced that. When these muscles in your middle ear spontaneously contract, it can lead to a rhythmic sound, but it doesn’t necessarily follow your pulse like pulsatile tinnitus would.

Patulous eustachian tube dysfunction

Another pretty rare cause of rhythmic sounds inside your head is something called patulous eustachian tube syndrome. Normally, the eustachian tube, which connects the middle ear to the back of your nose, remains closed and only opens briefly during activities such as swallowing or yawning.

However, with patulous eustachian tubes, your tube might stay open more often, which allows the sound of breathing and speaking to be transmitted directly to your middle ear, creating this rhythmical tinnitus-type sound.

How is pulsatile tinnitus investigated?

So, if you have pulsatile tinnitus how can you find out the most likely cause? If I come across anybody in the clinic who experiences pulsatile tinnitus, I will immediately refer them to an ENT to look into that cause.

Normally, they’ll start by taking a detailed medical history and performing a physical examination which focuses on your head, neck, and ears. Believe it or not, they may even attempt to listen to your pulsatile tinnitus themselves using a stethoscope.

There are various tests that will help to pinpoint the exact cause of your pulsatile tinnitus, which is crucial for finding the right treatment for you. These can include imaging tests such as an MRI or CT scan, which will provide detailed images around your head and neck, and even an ultrasound can be performed to check the blood flow in your neck.

ent investigation for pulsatile tinnitus

What happens if pulsatile tinnitus is left untreated or uninvestigated?

It’s important to mention here that more often than not, pulsatile tinnitus is nothing that you need to worry about. But you should definitely head over to your doctor for further investigation so that they can rule out any dangerous causes.

In very extreme cases when it’s not treated and it’s an indication of something more sinister, there is the rare possibility that whatever is causing your tinnitus could also lead to blindness, strokes, issues with walking or talking, or even fatality.

So, as you can appreciate, this is why I recommend having it investigated as soon as possible, so a doctor can determine whether your pulsatile tinnitus is dangerous or not. Assuming that it’s nothing sinister, there are also a handful of lifestyle changes that you can personally make to reduce your own tinnitus, and I’ve outlined them in the video below.

If you’d like any further information about this or any other hearing query please call 020 7486 1053 or complete the form below .

What is Pulsatile Tinnitus? Seek IMMEDIATE Medical Advice Video

Matthew Allsop is a Partner at Harley Street Hearing and the content creator for Hearing Tracker, where he shares his honest opinions on all things to do with hearing health and hearing aid technology. Hearing Tracker is the world’s first truly independent resource for hearing aid customers. You can watch his video on pulsatile tinnitus below.

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