Pulsatile Tinnitus

What Is Pulsatile Tinnitus?

People with pulsatile tinnitus often hear rhythmic thumping, whooshing or throbbing in one or both ears. Some patients report the sounds as annoying. But for others, the sounds are intense and debilitating, making it difficult to concentrate or sleep.

Pulsatile tinnitus differs from the more common, constant form of tinnitus. While even pulsatile tinnitus is often benign, it is more likely to have an identifiable source and may be the first sign of a more serious underlying condition.

Pulsatile tinnitus occasionally goes away on its own. However, ince it can be caused by potentially dangerous conditions, patients experiencing pulsatile tinnitus symptoms should undergo a thorough medical evaluation. Fortunately, pulsatile tinnitus can often be successfully treated and cured once the underlying cause is identified.

Symptoms of Pulsatile Tinnitus

The most common symptom of pulsatile tinnitus is regularly hearing a steady beat or whooshing sound. The beat or sound is often in synch with the patient’s heartbeat. When their heart rate increases, the beat or sound will become faster; when it decreases, the beat or sound will slow.

While it is common for people to hear their heartbeats if their heart is pounding hard, people with pulsatile tinnitus often hear it even when they have not exerted themselves. Pulsatile tinnitus symptoms may also be more noticeable at night while you’re lying in bed, because there are fewer external sounds to mask the beat or sound.

The beat or sound may come and go, or it may be constant. Many patients with pulsatile tinnitus find their symptoms to be distracting and loud, and interfere with their daily lives.

Causes of Pulsatile Tinnitus

In many cases, doctors can pinpoint an underlying health problem behind pulsatile tinnitus.

Atherosclerosis

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.

Blood Vessel Disorders and Malformations

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.

Ear Abnormalities

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.

High Blood Pressure

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

Head and Neck Tumors

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 in close proximity to the ear.

Idiopathic Intracranial Hypertension

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.

Sinus Wall Abnormalities

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 surround the sigmoid sinus in the mastoid.

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

Other Causes of 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

Diagnosis of Pulsatile Tinnitus

If you suspect that you have pulsatile tinnitus, you should undergo a thorough medical evaluation by an otolaryngologist who is familiar with the condition.

For about a third of patients, the source of their pulsatile tinnitus may be unknown but it is important to rule out the serious possible causes. Physicians at Penn Medicine have developed a comprehensive program to streamline the evaluation and potential treatment of pulsatile tinnitus.

The team will first ask about your medical history and conduct a thorough exam of your head and neck. Your eyes may be checked to look for any signs of increased pressure in the brain.

The following imaging procedures may also be used to diagnose pulsatile tinnitus:

• Angiography
• Computerized tomographic angiography (CTA)
• Computerized tomography (CT) scan
• Magnetic resonance angiography (MRA)
• Magnetic resonance imaging (MRI)
• Temporal bone CT scan
• Ultrasound

Blood tests and thyroid function test may also be needed to rule out anemia or thyroid problems.

Pulsatile Tinnitus Treatment at Penn

The underlying cause of pulsatile tinnitus must first be identified before the appropriate treatment can be determined. The comprehensive team at Penn Medicine Penn has the expertise and resources needed for optimal evaluation and treatment.

Once the problem has been identified, the cure rates for pulsatile tinnitus are high.

Treating Underlying Health Conditions for Pulsatile Tinnitus

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.

Techniques for Managing Pulsatile Tinnitus Symptoms

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

Contact the Penn Pulsatile Tinnitus Team

For more information on pulsatile tinnitus care at Penn Medicine or to schedule an appointment, please email our team at PT@pennmedicine.upenn.edu

Penn Programs & Services for Pulsatile Tinnitus