Tinnitus and Pulsatile Tinnitus Treatment Options That Work

A persistent “ringing,” “buzzing” or “beating” sound inside your ear is as loud as your own mind and can be unbearable. You might want to know what is happening, and more importantly, what really helps.

Tinnitus is simply defined as any sound you can hear that comes from within your own body, rather than from external sources. Pulsatile tinnitus is a subcategory of tinnitus where the sound is beating in sync with the beat of your heart. People commonly refer to tinnitus and pulsatile tinnitus interchangeably, but the two conditions differ in their mechanisms and treatments.

This guide will provide information regarding the differences between tinnitus and pulsatile tinnitus , how medical professionals consider the difference, whether one can occur with the other, and which treatment options have been backed by scientific research. This guide’s focus is on providing the reader with practical solutions for reducing symptomology, while the reader understands that there are no known remedies for eradicating the sounds completely.

What Are Tinnitus and Pulsatile Tinnitus and How Are They Different?

While Tinnitus and Pulsatile Tinnitus are both about hearing sounds other’s don’t; these sounds may vary in volume, frequency & pattern (i.e., steady, intermittent). They can also vary as to when they are heard; some only at night while for others it is all-day.

While many people tend to use these terms synonymously; for your treatment purposes, this is a very important distinction.

Simple Definitions: Tinnitus and Pulsatile Tinnitus Explained

Tinnitus is described as the perception of an internal sound without external origin; common examples of sounds that are heard by people experiencing tinnitus include:

• A ringing or a high pitched tone
• A buzzing or electrical or insect sounds.
• A hissing or whooshing sound.
• A humming or clicking sound.

There is another type of tinnitus called “pulsatile” tinnitus; it is characterized by a sound that coincides with the person’s heart beat (pulse). A few examples of what people may describe hearing when they have pulsatile tinnitus include:

• Whoosh whoosh sounds, similar to the sound of running water or wind.
• Thumping or drum sounds that occur at a rhythmic pace.
• Sounds that increase in volume as the person’s heart rate increases.

In simple terms, a direct comparison between regular tinnitus and pulsatile tinnitus is:

• Regular tinnitus: a steady or fluctuating sound with no correlation to the person’s heart beat.
• Pulsatile tinnitus: a rhythmic sound that synchronizes with the person’s heart beat.

Similar to regular tinnitus, both forms of tinnitus can range from mildly annoying to extremely distressing, depending on their severity.

Pulsatile Tinnitus vs Tinnitus: Why the Cause Often Matters

In many cases, the biggest difference between what is described as “tinnitus” and what is referred to as “pulsatile tinnitus” is typically the underlying reason for which the person develops tinnitus.

Typically, the common reasons for developing non-pulsatile tinnitus are:

Pulsatile tinnitus more often relates to blood flow or pressure changes near your ear or in your head. Common causes include:

– Hearing damage due to excessive exposure to loud noise;

– Age-related hearing loss;

– Certain medications;

– Jaw or neck problems;

– Ongoing health problems (diabetes, thyroid disease, etc.)

Non-pulsatile tinnitus more often than not relates to blood flow or pressure changes that occur close to the ear or within the skull. More typical causes of non-pulsatile tinnitus include:

– High blood pressure;

– Anemia (low red blood cell count);

– Narrow or twisted blood vessels;

– Raised pressure in the cerebrospinal fluid surrounding the brain;

Tinnitus, especially when it appears as pulsa- tive tinnitus, has historically been considered by doctors to be an emergency because it may indicate a vascular issue that requires immediate treatment.

Can You Have Tinnitus and Pulsatile Tinnitus at the Same Time?

Some may also wonder, “Can I have tinnitus and pulsatile tinnitus simultaneously?” Yes, many individuals experience both forms of tinnitus concurrently.

Consider an analogy. A person hears:

• In quiet rooms, a continuous high-pitched ringing in both ears (a classic symptom of regular tinnitus).
• In addition to the constant tone, the person hears a rhythmic whooshing (or thumping) sound in their right ear (a classic symptom of pulsatile tinnitus).

Together these represent two different types of tinnitus: the consistent tones of regular tinnitus, and the rhythmic whooshes of pulsatile tinnitus. Both may coexist or may develop separately; they may occur months apart, or years apart.

If you experience tinnitus and pulsatile tinnitus together, you still need to see a physician to determine if your condition has caused any damage to your hearing system.

When You Should See a Doctor for Tinnitus and Pulsatile Tinnitus

You shouldn’t freak out if you get some ringing from that one loud concert – short term tinnitus can occur (and most of the time will go away). Ongoing tinnitus and particularly pulsatile tinnitus require medical attention as well as immediate evaluation for those who have experienced significant or rapid changes in their tinnitus, especially when compared to your typical experience.

This is true especially for those who may have pulsatile tinnitus; it would be nearly impossible to ignore, and should be evaluated by a physician. The more severe the tinnitus, and the more quickly it occurs, the higher risk of hearing loss or another serious condition. Additionally, tinnitus which has started suddenly, and/or is unilateral, may also be a sign of something more serious and should be evaluated immediately.

Red Flag Symptoms You Should Not Ignore

Some symptoms may necessitate emergency or urgent medical care as opposed to an appointment for a routine check-up for tinnitus and/or pulsatile tinnitus; specifically:

• Sudden hearing loss in one ear.
• Pulsatile tinnitus on one side only (usually indicates an arterial anomaly).
• A severe headache that differs from other headaches.
• Weakness or drooping of facial muscles on one side.
• Double vision or blurred vision.
• Chest pain, shortness of breath, or palpitations.

These signs indicate that you may have potentially serious vascular or nervous system disease such as a stroke, hypertensive emergency, or cardiac disease. While these conditions are relatively rare, they require prompt treatment.

What to Expect at Your First Visit for Tinnitus and Pulsatile Tinnitus

The primary goal of your first appointment with a physician or Ear Specialist (an Audiologist) is to determine the nature of your sounds and their cause. Your doctor will likely ask a series of questions to better understand your tinnitus and/or Pulsatile Tinnitus symptoms. These questions may include:

• The characteristics of your sounds: (pitch, rhythm), how long you’ve had them, factors that make them worse/better.
• Your doctor may perform a visual examination of your ears (i.e., otoscopy) to assess the presence of earwax, infection or trauma.
• A hearing evaluation (audiogram) to evaluate possible hearing loss.

If you experience Pulsatile Tinnitus, your physician may also want to:

• Take a history and possibly measure your blood pressure and heart rate.
• Perform blood work to identify potential anemia or thyroid conditions.
• Possible imaging studies (e.g., CT, MRI, Ultrasound) to visualize your blood vessels.

While these tests may seem invasive, they are routine and necessary to provide for your safety. Prior to your appointment, please document your key questions and create a one-page symptom diary for a couple of weeks prior to your visit. This documentation will help your healthcare team to note patterns in your symptoms and develop the most appropriate plan for further action.

Tinnitus and Pulsatile Tinnitus Treatment Options That Really Help

The most effective treatment will be different for each person suffering from tinnitus, however, a number of treatments exist to help decrease the severity of tinnitus and pulsatile tinnitus symptoms in patients. A common denominator to achieving the best outcomes is by combining clinical interventions with both sound-based tools and brain-based tools.

Treatment options are divided into the following categories:

• Medical intervention for reversible causes when identified
• Sound-based interventions (therapy & masking)
• Sound-based interventions (hearing aids and combination hearing aids)
• Brain-based interventions (counseling/brain training techniques, CBT)
• Interventions for secondary issues that require medication or supplementation

You will have different priorities in each piece based on if your primary concern is regular tinnitus or pulsatile tinnitus.

Treating the Root Cause: When Medical Problems Trigger Tinnitus and Pulsatile Tinnitus

In many cases, when you identify the underlying cause of tinnitus and/or pulsatile tinnitus, treatment of this cause is very effective at helping alleviate the symptoms.

Examples:

• Treatment of an ear infection using appropriate antibiotics
• Removal of a large amount of impacted earwax
• Treatment of high blood pressure through life style modifications or medications
• Treatment of anemia with iron supplements and/or other treatments
• Stopping a medication known to be associated with tinnitus
• Surgical or procedural correction of a vascular problem (e.g., relieving a kinked or enlarged artery causing pulsatile tinnitus)

Identifying the specific blood vessel or pressure source causing the pulsatile tinnitus can often eliminate the pulsatile sound entirely. Therefore, it is critical to provide as much detail as possible regarding all aspects of tinnitus and/or pulsatile tinnitus symptoms, including frequency, triggers, etc. to your physician.

Sound Therapy and Masking: Helping Your Brain Tune Out the Noise

Your brain focuses on the loudest of all the sounds it hears, if your room is extremely quiet then the sound of tinnitus and/or pulsatile tinnitus will be louder than everything else; Sound Therapy adds consistent soft sound to create an environment where tinnitus &/or pulsatile tinnitus are no longer prominent.

There are several types of sounds that work well for Sound Therapy:

• White Noise Machines/Fans (at night)
• Sounds of Nature (rain, ocean etc.)
• Instrumental Music with low volume/level

Sound Masking is usually used when:

• going to sleep
• working at a desk
• reading/relaxing in a quiet room

In time, Sound Therapy trains your brain to think of the tinnitus/pulsatile tinnitus as “background” noise much like traffic noise outside a window.

There are many apps and products that allow you to choose the type of tone(s), and how loud you want them, which allows you to tailor the sound(s) to fit your needs/hearing level.

Hearing Aids and Combination Devices for Tinnitus and Pulsatile Tinnitus

Aging, exposure to loud noises and ear infections are some common causes of hearing loss and tinnitus, as a person’s hearing decreases, their brain is forced to “amplify” the internal noises of the tinnitus.

Hearing aids can help in reducing the severity of both hearing loss and tinnitus in many ways:

• The clarity of everyday conversation and other sounds will improve, so you’ll be able to communicate better.
• The amount of ambient (background) sound coming into the hearing aid will increase; this can create an overall effect of a quieter tinnitus.
• The contrast between the tinnitus and the quietness of the environment will decrease, creating an improved perception of the tinnitus.

In addition to these features, most modern hearing aids come equipped with one or two special tinnitus programs:

Some hearing aids can produce low-level white noise or tone that blends with the tinnitus signal, effectively covering it.

Tinnitus relief through hearing aids may also be beneficial for individuals who suffer from a type of tinnitus known as pulsatile tinnitus along with hearing loss. However, it is crucial that the individual first determines the root of the pulsatile tinnitus, because hearing aids will not address the vascular problem.

Counseling, CBT, and Mindfulness: Training Your Brain’s Response

Cognitive Behavioral Therapy (CBT) and other types of counseling do not eliminate the sound. Instead, CBT changes how you respond to the sound.

For many people who experience tinnitus or Pulsatile Tinnitus, their minds jump to the conclusion “this will be crazy-making” or “I will never get a good night’s sleep again.” The goal of CBT is for you to become aware of these thoughts, challenge the validity of these thoughts and replace them with more rational and balanced thoughts, e.g., “the sound was louder than usual today, but I’ve dealt with it before,” or “I have some tools that may help me sleep better.”

Ultimately, through repeated practice and reinforcement, the cognitive restructuring that occurs in CBT can:

• Lessen feelings of stress and/or fear
• Decrease anxiety and depression
• Help you sleep and pay attention during the day

There is evidence from research indicating that CBT can decrease how bothersome tinnitus is for patients, even if there are no significant reductions in the intensity of the tinnitus sounds themselves.

Medications, Supplements, and What Actually Has Evidence

There isn’t a magic solution that will cure tinnitus and pulsatile tinnitus for every individual. Therefore, be cautious of websites and advertisements that suggest an immediate and permanent fix by simply taking a bottle.

While medications may offer some benefits in addressing associated issues (e.g., anxiety, depression, sleep disturbances), the first step is typically treating these underlying concerns. Once the linked issues are being addressed, there will likely be more space within the brain for it to work with the tinnitus.

In addition, many individuals attempt various supplements including, but not limited to: Ginkgo, Zinc, Magnesium and/or Herbal Blends. While research has shown mixed results regarding whether these supplements benefit or do not affect tinnitus sufferers, many report feeling better while others claim to see little or no difference. As a result, certain supplements may interact with prescribed medications and produce side effects.

Prior to initiating any supplement, consult with a physician or pharmacist especially if you are currently taking any medications and/or have chronic health-related conditions (i.e. hearing loss) associated with tinnitus and pulsatile tinnitus.

Daily Habits to Calm Tinnitus and Pulsatile Tinnitus Over Time

Medical treatment and technology are just two sides of the coin. Your daily routine is also a factor in how loud and annoying tinnitus sounds. With small, consistent changes you can see improvement over several months.

The goal here is to help you with these three main things that you can do at home: ear protection, reducing your stress level, and better tracking of symptoms.

Noise damage can cause both hearing loss and increase the intensity of tinnitus. The idea is to protect yourself from excessive noise without creating an irrational fear of making any noise.

Protect Your Ears Without Avoiding Life

Use earplugs or earmuffs at concerts, in nightclubs, or when working with power tools to keep your ears safe from excess noise.

When wearing headphones, try keeping the volume at around 60 percent and limit how much time you spend listening for extended periods.

Take regular breaks from listening to music, etc., by taking 5 minutes off every 30-60 minutes of listening.

Do not wear earplugs too often in quiet environments. Wearing them continuously in quiet spaces may make tinnitus and pulsatile tinnitus seem worse due to increased quietness.

Stress, Sleep, and Food: Small Choices That Add Up

Habits that promote good health and wellness can make it easier for you to manage your tinnitus and make it less bothersome when you experience it. Stress, poor sleep and certain food and drink choices can all increase how loud tinnitus (and Pulsatile Tinnitus) seems.

To provide your body’s nervous system with what it needs to keep running smoothly, try these habits:

• Stick to a consistent sleep schedule, including on weekends
• Try to have a five minute “wind down” time each night (reading, stretching, deep breathing etc.) before bed.
• Do some form of low impact physical activity (yoga, walking, etc.) at least three times per week.
• Pay attention to whether or not caffeine, alcohol, salty food etc. triggers increased volume of the noise(s), and limit consumption accordingly.

Consistency is the goal; small steps will lead to better management of tinnitus.

Tracking Your Symptoms So Treatment Works Better

Keeping a record of the times when your tinnitus and/or pulsatile tinnitus are strongest can convert guesses to a pattern. Keep a paper or app-based log of each episode which includes:

• When did it occur (date, time)
• What type of sound do you hear (ringing, buzzing, whistling, pulse)
• What were you doing, eating, feeling at the time?
• Was there something that helped (masking, resting, being quiet)?

Take these notes with you to each appointment. This will give your doctor insight on your triggers, and for how effective your treatments have been. A good journal can be an indicator of slow but sure improvement that you may miss in your everyday activities.

Conclusion: Moving Forward With a Clear Plan

Your understanding of tinnitus, and more specifically pulsatile tinnitus, as well as the differences between these two conditions has become much clearer. Additionally, the importance of identifying the underlying causes of either tinnitus condition, and the associated treatments, is more apparent.

Tinnitus usually relates to hearing loss or ear damage; whereas, Pulsatile Tinnitus may relate to vascular issues (blood flow) or pressure issues requiring a detailed review by a medical professional.

The overall message is positive. While it is unlikely that the ringing will completely disappear, many people find ways to decrease the volume of the tinnitus in their lives, and regain some level of control. By combining medical care with the use of sound tools, brain based strategies, and daily routines, many individuals are able to improve their quality of life.

An example of an easy-to-follow plan would be:

1. Schedule a medical appointment (especially if your symptoms started recently, are unilateral (one sided), or if you experience pulsatile tinnitus).
2. Begin using gentle sound therapy at night to help improve your sleep.
3. When going out to loud events, protect your ears; and when listening to music through headphones, do not listen too loudly.
4. For a few weeks try a short daily relaxation technique along with keeping track of your symptoms in a journal.
5. If stress, anxiety, or sleep disturbances have significantly impacted your tinnitus story, ask your doctor if he/she recommends Cognitive Behavioral Therapy (CBT) or counseling.

Do not attempt to solve all of your problems at once. Select one area where you feel comfortable taking one small step, and continue to build upon each small step you take. As you continue to move forward, over time, each of the small steps can collectively reduce the frequency of your tinnitus and reduce the amount of attention your brain gives to the tinnitus, allowing you to better focus on the things you value most in life.