Pulsatile tinnitus

Plaque builds up inside the arteries in people with atherosclerosis. When plaque hardens, it narrows the arteries and limits the flow of blood to the body, including in your ears, neck or head. This may cause you to hear the characteristic rhythmic thumping or whooshing sound of pulsatile tinnitus in one or both of your ears.

Pulsatile tinnitus is often caused by disorders or malformations in the blood vessels and arteries, especially those near the ears. These abnormalities or disorders — including aneurysms and arteriovenous malformations — can cause a change in the blood flow through the affected blood vessels.

Superior semicircular canal is one of three canals found in the vestibular apparatus of the inner ear. Patients with superior semicircular canal dehiscence syndrome, a condition in which part of the temporal bone that overlies the superior semicircular canal is abnormally thin or missing, often experience pulsatile tinnitus.

Thinning or missing bone overlying the main arteries and veins running near the ear can also lead a patient to hear their heartbeat.

When blood pressure is high, your blood flow through the carotid artery is more likely to be turbulent, causing a pulsating sound.

Glomus tumors of the head and neck are benign but locally invasive tumors that arise from glomus cells. These tumors are most common in part of the jugular vein that’s positioned below the middle ear. Glomus tumors may grow into the middle ear and brain.

When these tumors press on the blood vessels in the head or neck, they can cause pulsatile tinnitus and other symptoms. Glomus tumors are highly vascular and can cause also pulsatile tinnitus just by being close to the ear.

This is a health condition caused by elevated cerebrospinal fluid pressure around the brain. This elevated pressure presents with symptoms like headaches, double vision, pain behind the eye and pulsatile tinnitus.

These abnormalities include sigmoid sinus diverticulum and dehiscence. The sigmoid sinus is a blood-carrying channel on the side of the brain that receives blood from veins within the brain.

Sigmoid sinus diverticulum refers to the formation of small pouches (diverticula) that protrude through the wall of the sigmoid sinus into the mastoid bone behind the ear. Dehiscence refers to the absence of part of the bone that surrounds the sigmoid sinus in the mastoid.

These abnormalities cause pressure, blood flow and noise changes within the sigmoid sinus, resulting in pulsatile tinnitus.

These conditions can also cause the characteristic thumping or whooshing sound of pulsatile tinnitus:

• Anemia
• Conductive hearing loss
• Head trauma
• An overactive thyroid gland (hyperthyroidism)
• Narrowing of the blood flow tracts out of the brain
• Paget’s disease

Since pulsatile tinnitus can be caused by a variety of underlying health conditions, an in-depth evaluation will help Penn physicians create a personalized treatment plan for you.

If your doctor determines that your pulsatile tinnitus is caused by hyperthyroidism, elevated intracranial pressure or anemia, treatment may include medications. High blood pressure may also be treated with medication, in combination with lifestyle changes like exercise, smoking cessation and weight loss.

If your evaluation reveals that a blood vessel disorder or malformation, tumor or ear abnormality is causing your pulsatile tinnitus, your doctor will likely recommend otological or neurological surgery to correct that underlying condition. This is occasionally combined with adjunct therapy, such as stenting for aneurysms.

If there is no underlying condition causing your pulsatile tinnitus, your doctor may suggest self-management techniques to help alleviate your symptoms.

In some cases, sound therapy may help to suppress the thumping or whooshing sound caused by pulsatile tinnitus.

Your doctor may recommend using a noise-suppressing device, such as a white noise machine or a wearable sound generator. The sound of an air conditioner or fan may also help, particularly at bedtime.

Some lifestyle and behavioral modifications can help alleviate the symptoms of pulsatile tinnitus as well.

The following therapies may be beneficial for some patients with pulsatile tinnitus:

• Cognitive behavioral therapy
• Meditation
• Relaxation techniques
• Tinnitus retraining therapy