Pulsatile Tinnitus: Complete Guide (With 7 Treatment Options)

Do you hear that? Listen to that sound. It sounds like washing, almost like the rhythm of a heartbeat. In this article, I’m going to give you a complete guide to pulsatile tinnitus. Pulsatile tinnitus is a medical condition where you hear sounds, coming from what seems like your ears or your head, that are related to your heartbeat or the rhythm of your cardiovascular system. Pulsatile tinnitus is not always caused in the ear. So where does it come from?

Pulsatile tinnitus is a medical condition where you hear a noise or sound from your body that is synchronized with your heartbeat. In this article, we will cover symptoms, potential causes, and various treatments of the pulsatile tinnitus sound.

My name is Ben Thompson. I’m an audiologist in California and the founder of PureTinnitus. Today I’m going to explain the symptoms of pulsatile tinnitus, seven potential causes, and the various treatment options that can help you to reduce that noise you’re hearing throughout your day and at night when you’re trying to fall asleep. 

Dr. Thompson explains potential causes of pulsatile tinnitus.

Where Does Pulsatile Tinnitus Come From?

Pulsatile tinnitus is a medical condition where you hear noises coming from somewhere in your ear, your head, or your body that are synchronized with your heartbeat. The pulse is why we use the term “pulsatile” for this type of tinnitus. Sometimes it can sound like a whooshing or swishing noise, and it has some rhythms, some natural fluctuations to it. Typically, it’s louder in a quiet place where there aren’t other noises to distract us. Pulsatile tinnitus is usually perceived unilaterally, or just in one ear, and it’s a rarer type of tinnitus. More commonly, tinnitus is perceived as a high-pitched ringing or buzzing sound in the ears. But pulsatile tinnitus is less common and is distinctly different. Fortunately, in about 70% of cases of pulsatile tinnitus, the medical team can diagnose the cause and treat it effectively. The medical team typically consists of your primary doctor, a ear, nose, and throat doctor, a neurologist, and sometimes a cardiologist as well.

Common Symptoms of Pulsatile Tinnitus

So let’s talk about pulsatile tinnitus symptoms. The first symptom is that you consistently hear a noise in your ear that seems to match the fluctuation of your heart. This could sound like a swishing, or sound and feel more like a heartbeat itself. It’s also common to have headaches and lightheadedness, because pulsatile tinnitus is often related to a cardiovascular condition that’s going on in the body. People frequently think that the cause of pulsatile tinnitus is in the ear, because that’s where you’re hearing it, but this isn’t always true.

The diagnosis of pulsatile tinnitus typically comes from a few tests: first a hearing test, sometimes followed by an MRI or a CT imaging study, and then also potentially some blood tests to help understand the relationship between your cardiovascular system and your ear, where you’re perceiving the sound of the tinnitus. Some important questions we want to ask when we’re considering the different symptoms of pulsatile tinnitus are, do you also have vertigo, dizziness, ear pain, and/or hearing loss? If any of those are true, then your condition may be related more to your ear than your cardiovascular system. So getting a hearing test and speaking with your doctor is really all you need to do to make sure your problem is not related to the ear, versus some other form of pulsatile tinnitus.

What Is The Most Common Cause of Pulsatile Tinnitus?

Okay, let’s talk about the different causes of pulsatile tinnitus. I found seven examples of potential causes. If you’ve already gone to different doctors, and you’re still wondering what’s the cause of your pulsatile tinnitus will turn out to be, this may help you. Of course, trusting your own doctors is important. If you’re not sure if your doctor is qualified, then it may be in your best interest to go to a large medical center in a city, where they have more experience and see a greater number of these kinds of cases.

A lot of the potential causes of pulsatile tinnitus are related to cardiovascular conditions. “Cardiovascular” essentially refers to the flow of blood as it goes out and comes in, either from the heart to other parts of the body, or from parts of the body, like our ears, to the heart. The first cause could be abnormal vascular conditions that are affecting the membrane layers covering the brain. The second could be irregular blood vessels, specifically in the carotid artery, which is the pathway that blood travels from your heart to your head.

Some kinds of pulsatile tinnitus in both ears can be caused by pressure on myofascial points in the neck or the face. Sometimes different trigger points in the muscles can cause the pulsatile tinnitus. Specific eye movements can also trigger it, as well as certain muscle contractions of the neck or the jaw.

The fourth possibility is a growth in the hearing system. This is a condition where part of the eardrum space, the hearing organ, or the hearing nerve has some sort of physical abnormality that’s causing the pulsatile tinnitus. That would be identified by imaging studies that your doctors would order.

A fifth reason for pulsatile tinnitus symptoms could be an inner ear condition called a canal dehiscence, which is related to the vestibular function of the inner ear. Intracranial pressure, or pressure inside of your head, could also be a culprit. This can be caused by the veins that are designed to bring used blood back from the head into the heart.

The seventh potential cause of pulsatile tinnitus that I want to share with you is called a patulous Eustachian tube. The Eustachian tube is a passageway that connects from the back of the throat, up near the nose and behind the eardrum. When you feel pressure in your ears and blow out to fix it, that’s sending air through your Eustachian tubes to “pop” your eardrums. Under normal circumstances, the Eustacian tube will remain closed when there’s no air blowing through it, but sometimes people have a Eustachian tube that remains open. That can lead to a perception of pulsatile tinnitus as well.

What we’ve just covered are some of the different causes of pulsatile tinnitus, but of course, there could be more. The only way you’re really going to know is by working with your medical team to help diagnose your particular case. Still, I wanted to give you those to get you on the right track, and to help you understand what might possibly be going on.

Treatment Options For Pulsatile Tinnitus

Next, let’s talk about the treatment options for pulsatile tinnitus. The effectiveness of treatment really depends on the cause. And like we just discussed, there could be any of a number of causes of your pulsatile tinnitus. If you’re working with the right kind of doctors who know what they’re doing, once they can actually diagnose what’s going on and treat it, the sound of your pulsatile tinnitus should go almost or even completely away.

Your treatment may involve medication, or changes to your diet or exercise habits. It may also involve a surgical procedure to remove a physical abnormality or repair a physical structure in your body, whether that’s in the ear, the hearing pathway, some part of the head, the membranes around the brain, or the cardiovascular system.

If your problems with pulsatile tinnitus continue even after you’ve worked with a talented medical team, there are a few things you can do. Number one would be to get a second opinion from a different medical center. I recommend going to a big city; one that has a clinic devoted to pulsatile tinnitus would be excellent. You can go online to try to search for one.

If you’re still left with symptoms, it’s advisable to work with an audiologist like myself, who can focus on sound therapy and tinnitus therapy, or treat your neural pathways to try and reduce your sensitivity to the sound itself.

To learn what may help you manage your tinnitus, please download our free 10-page e-book, The Ultimate Guide to Tinnitus Relief. Dr. Thompson also offers online Tinnitus Retraining Therapy with Pure Tinnitus.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson is an audiologist in California and founder of Pure Tinnitus. Dr. Thompson has a comprehensive knowledge of tinnitus management. He completed his residency at University of California at San Francisco (UCSF) and is a past board member of the California Academy of Audiology. Via telehealth, Dr. Thompson provides services to patients with hearing loss and tinnitus.

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