In the population of people who experience tinnitus, a very small percentage is affected by what is known as pulsatile tinnitus: a whooshing sound that occurs in the middle ear in time with a heartbeat. This occurs when blood vessels in the head or neck experience increased blood flow or a narrowing of the blood vessel opening and the sound differs from the tinnitus caused by damage to the inner ear or middle ear (in those cases it is more of a ringing or buzzing sound).
Treatment of the vascular issues that caused the pulsatile tinnitus to appear can resolve the issue, but it is important to undergo a full physical evaluation to determine the specific cause. The underlying conditions associated with pulsatile tinnitus can be a sign of a serious problem (for example, in rare cases, a stroke could be imminent). Also often referred to as objective tinnitus, it is the only type of tinnitus that can be heard by an observer—a physician can typically hear the sound with the aid of a stethoscope.
As with all types of tinnitus, pulsatile tinnitus can disrupt and affect the overall quality of life, sometimes leading to sleep problems, difficulty concentrating, anxiety, and even depression. Therefore, it is important to contact a physician immediately to address the underlying issues and seek treatment if necessary.
Causes of pulsatile tinnitus
The underlying causes of pulsatile tinnitus all have in common that they are related to circulation issues. These conditions have each been seen to cause pulsatile tinnitus:
Capillaries are the tiny vessels that connect arteries to veins and abnormalities in the capillaries can be the root cause of pulsatile tinnitus.
Atherosclerosis occurs when your arteries have a blockage caused by the buildup of cholesterol, fats, and waste, which, in turn, result in turbulent blood flow. This abnormality in the blood flow can then create the pulsing, rhythmic noise in the ear.
Tumors in the head or neck
In some instances, pulsatile tinnitus can be tied to the presence of a tumor in the head or neck, which is essentially pressing against a vein.
Turbulent Blood Flow
When the arteries and veins in the neck (carotid and jugular, respectively) are narrowed, this can change the way blood flows to and from the head, causing pulsatile tinnitus.
How pulsatile tinnitus is diagnosed
Pulsatile tinnitus can be diagnosed by a physician. A doctor will perform a full exam to try to determine the source of the tinnitus and a detailed discussion of your medical history will be part of this exam. Using a stethoscope to listen to the patient’s chest, neck, and head, the doctor will either hear the pulsing noise (determining the patient has objective pulsatile tinnitus) or not (determining the patient has subjective pulsatile tinnitus). An audiological exam will be reviewed to determine if hearing loss is present in one or both ears and imaging tests (such as an MRI or ultrasound) may be ordered as well. A pulsatile tinnitus diagnosis will likely result in the patient being referred to a cardiologist to further investigate the circulatory issues that caused the tinnitus.
How pulsatile tinnitus is treated
The key to addressing pulsatile tinnitus is to address the underlying cause: a physician will treat the circulatory issue in a variety of ways, which can in most cases lead to a reduction in tinnitus, or it going away altogether.
- If the pulsatile tinnitus stems from high blood pressure or artery conditions, both medications and lifestyle changes can be used to address the problems. These include, but are not limited to: smoking cessation programs, engaging in exercise and a healthy lifestyle, following a low-sodium diet, and taking steps to reduce stress.
- If pulsatile tinnitus is associated with a specific problem in a vein or artery, surgery may be advised to address the issue. The use of stents placed in blocked arteries to improve blood flow can, in turn, address the presence of pulsatile tinnitus.
- If for whatever reason the circulatory issue cannot be resolved by medical intervention, some tinnitus sufferers use “sound therapy” as a means to manage the issue. “White noise” can act as a distractor, allowing the individual to focus less on the pulsating noise (and this is true for all types of tinnitus).
In addition, those suffering from all forms of tinnitus seek a wide variety of treatments aimed at providing relief, from the use of essential oils and supplements to acupuncture, massage, and breathing and relaxation techniques. A note of caution is always important in regard to supplements and vitamins intended to address tinnitus: these can interfere with existing medications and should always be discussed with a physician first.
Why does it typically occur in one ear only?
The source of the pulsatile tinnitus plays into the fact that individuals often hear it in one ear only. For example, when pulsatile tinnitus occurs because of a tumor, that tumor is only affecting the ear it is located near or is disrupting with pressure on a vein. Alternatively, the abnormal vein and artery connection may be located next to one ear only. While the presence of tinnitus in one ear only does not always mean pulsatile tinnitus, it is usually a good indicator that this is the type the individual is experiencing.
Does pulsatile tinnitus ever go away on its own?
It is possible that pulsatile tinnitus will resolve on its own, though it is still advised you seek the input of a physician, especially if you have experienced it for more than a few weeks. This cue from your body might the first step in addressing a much more serious underlying issue and you will feel better to play it safe in this scenario.