Hearing a rhythmic throbbing, thumping, or “whishing” noise in one or both ears is indicative of pulsatile tinnitus. Unlike the constant, uniform humming or hissing of regular tinnitus, pulsatile tinnitus causes people to feel like they are hearing their heartbeat inside their ears. This type of tinnitus can occur sporadically or continue for hours or days at a time. In most cases, the cause of pulsatile tinnitus can be detected by a series of tests and treated successfully with medications, lifestyle changes or minimally invasive surgery.
Symptoms of Pulsatile Tinnitus
Common signs of pulsatile tinnitus include:
- Hearing loud whooshing noises in the ear that tend to synchronize with your heartbeat. Faster heartbeats will increase the throbbing of the sound while slower heartbeats decrease the rhythmic whooshing noise
- Inability to sleep or concentrate because sounds are so loud and intense
- A feeling of uncomfortable fullness in the affected ear. Although pulsatile tinnitus is painless, the combination of throbbing, whooshing sounds, and hearing impairment due to constant noise may make it seem painful
A person may experience pulsatile tinnitus for a few days and not have another episode for weeks or months. In most cases, people with pulsatile tinnitus suffer recurring or constant symptoms of this condition.
Causes of Pulsatile Tinnitus
The primary cause of pulsatile tinnitus involves issues with the circulation of blood around and inside the ear. Consequently, a circulatory problem is often the reason behind pulsatile tinnitus. High blood pressure will force blood to flow more vigorously through carotid arteries that extend through the neck and into the head. Abnormalities affecting the superior semicircular canal in the inner ear can also provoke pulsatile tinnitus symptoms. Bone thinning impacting tiny bones surrounding veins or arteries near the ears may allow a person to hear the whooshing of their heartbeat, a sound normally muffled by healthy, dense bones. Anemia, hyperthyroidism, and conductive hearing loss are also underlying causes of pulsatile tinnitus.
When arteries narrow due to plaque buildup on inner walls, this constriction interferes with blood flow throughout the body. Your heart must pump harder to force blood in and out of arteries and veins. Stress on the circulatory system will naturally increase the sound of rhythmic whooshing and thumping in one or both ears.
A benign tumor called a glomus tumor may develop from abnormal glomus cells located in the middle ear and around the jugular vein. Containing thousands of tiny blood vessels, glomus tumors are “vascular” tumors that will cause symptoms of pulsatile tinnitus because they grow so close to the inner ear.
Sigmoid Sinus Diverticulum
The sigmoid sinus channel extends along one side of the brain where blood is received from veins that spread throughout the brain. When diverticula (tiny pouches of soft tissue) form and protrude into the sigmoid sinus wall, they will press against the mastoid bone and cause changes to inner ear pressure and blood flow. These changes usually result in the rhythmic, whooshing sounds characteristic of pulsatile tinnitus.
How is Pulsatile Tinnitus Diagnosed?
If an examination by an otolaryngologist does not find visible blockages within the Eustachian tube or ear canal, additional tests will be needed to determine the cause. Imaging scans can detect issues with the circulatory system, reduced bone density and possible signs of tumor growth. MRIs, CTs, ultrasounds and bone CT scans are tests commonly ordered to accurately diagnose pulsatile tinnitus.
Is Pulsatile Tinnitus Worse When Lying Down?
The throbbing or rhythmic whooshing sounds you hear if you have pulsatile tinnitus are almost always due to vascular conditions like high blood pressure. When lying down, your heart needs to pump harder to ensure blood flows to all areas of the body. Lying down amplifies the throbbing and whooshing sounds arising from the heart beating more forcefully. In fact, any positional changes such as standing up or sitting down may worsen pulsatile tinnitus symptoms. The quietness of a bedroom at night will also intensify the whooshing sounds in the ears, making it seem even louder after lying down.
Even if you are not bothered by pulsatile tinnitus noises during the day, lying down in bed at night can aggravate them to the point you cannot get to sleep. Fortunately, tinnitus treatment options are available for patients without apparent underlying cause.
What are My Treatment Options for Pulsatile Tinnitus?
White Noise Generators
A white noise generator is a small machine that emits a sound similar to a fan or air conditioner. Some noise generators offer the option of listening to nature sounds, like rain falling on pavement or crickets chirping.
Earbud Sound Generators
People who experience moderate to severe pulsatile tinnitus when lying down may prefer to wear a sound generator that resembles a hearing aid. The white noise emission is closer to their ears and offers an improved ability to drown out sounds.
Reducing High Blood Pressure
Medications, making healthier diet choices, exercising regularly, and learning stress reduction techniques may help decrease pulsatile tinnitus symptoms caused by hypertension.
Tumor removal, reconstructive procedures and other surgical treatments can reduce or eliminate pulsatile tinnitus. Stents may be inserted in veins narrowed by plaque or weakened by disease. Self-expanding stents open up veins to allow blood to flow more easily through them. Since the heart does not need to beat more forcefully, the beating sounds in the ear subside significantly.
Get Help with Your Pulsatile Tinnitus
While pulsatile tinnitus typically does not resolve on its own, there are a variety of treatments that can successfully manage symptoms. For more information about treating pulsatile tinnitus, please call Harbor Audiology today.