Pulsatile Tinnitus: Causes, Symptoms & Real Treatment Options

You could be hearing a whooshing, thumping, or heartbeat sound in your ear that keeps pace with your pulse. This is called pulsatile tinnitus.

Pulsatile tinnitus is different from the typical high-pitched ringing many people experience when they talk about “tinnitus.” With pulsatile tinnitus you hear the pulse of blood flowing through the vessels near your ear. Some of the time it is harmless. At other times, it may indicate your body is alerting you to some important issue.

Below is information regarding pulsatile tinnitus. You’ll learn what it is, what causes it, the warning signs to look for, and what makes it potentially hazardous. Additionally, below you will see how doctors diagnose pulsatile tinnitus and which tests they utilize, and what treatments may offer relief. After reading the information, you’ll be better prepared to ask your doctor the right questions so you don’t feel overwhelmed by that constant beat in your ear.

What Is Pulsatile Tinnitus (In Simple Terms)?

Pulsatile tinnitus is a sound in either one ear or both ears that synchronizes with your heartbeat. It commonly sounds like:

• Whooshing

• Thumping

• Pulse or flutter

It is easier to identify when you are lying down, sitting in a quiet space, or when you’re attempting to fall asleep. The defining characteristic is the fact that it beats with your pulse.

Regular tinnitus typically produces a consistent buzzing, hum, hiss, or ringing. It generally lacks rhythm and is not synchronized with your heartbeat. Pulsatile tinnitus is synchronous with your heart rhythm.

Pulsatile tinnitus is a symptom, not a disease. It is often related to blood flow near the ear or brain, changes in pressure within the cranial vault, or issues in the middle ear. The sound occurs when your auditory system picks up the movement of blood through vessels located next to the structures of the ear.

How Pulsatile Tinnitus Feels Different From Regular Tinnitus

If you’ve experienced both, you probably agree they feel quite distinct.

Typical tinnitus is often described as:

• A continuous buzzing, ringing, hissing, or humming

• High pitched

• Not beating with your pulse

• Almost always present, or nearly always present

On the other hand, pulsatile tinnitus is characterized by:

• Beats with your heartbeat

• Can produce a whooshing, thumping, or pulsating effect

• May increase in volume when you are physically active, climbing stairs, or experiencing emotional distress

• May decrease in volume when you apply pressure to your neck, or turn your head

You may hear it in one ear or both ears. Most individuals describe it as most bothersome at night when their environment is quiet and they’re attempting to fall asleep.

Recognizing these distinctions will enable you to communicate the nature of the sound to your doctor, which is an initial step toward getting the correct answers.

Pulsatile Tinnitus In One Ear Or Both Ears

The term “pulsatile tinnitus ear” is frequently seen when you research online. That’s due to the fact that the location of the sound in the ear and its configuration can provide the doctor with useful clues.

One ear (unilateral): Pulsatile tinnitus occurring in one ear may be more concerning. It may indicate a localized issue, i.e., a blood vessel near that ear, a middle ear tumor, or a structural anomaly. New, unilateral pulsatile tinnitus should be evaluated promptly.

Both ears (bilateral): If you experience pulsatile tinnitus in both ears, the cause is likely to be systemic. Examples of possible systemic factors include high blood pressure, anemia, or elevated pressure in the area surrounding the brain.

Your doctor will also be concerned about:

• Volume: How loud is it? And does it vary?

• Timing: Is it constantly present? Or does it occur and then disappear?

• Position: Does it alter based upon whether you lie flat, bend over, or change the direction of your head?

By providing these additional details, you’ll assist your doctor develop a map that can direct him/her toward the appropriate tests and treatment.

Main Causes Of Pulsatile Tinnitus (And Which Are Dangerous)

Pulsatile tinnitus originates from one of these three main categories of causes:

• Blood vessel and circulation problems near the ear or brain

• High blood flow states and heart-related causes

• Pressure changes around the brain and spinal column

• Ear, sinus, and middle ear problems

• Less common but potentially dangerous conditions, including certain tumors and abnormal blood vessel connections

Some of the reasons pulsatile tinnitus occurs are harmless or mild; others may be harmful if neglected. Therefore, you cannot accurately determine the reason for your case merely by reading online. Thus, it is essential to obtain professional evaluation — even if you are experiencing few or no symptoms.

Blood Vessel And Circulation Problems Around The Ear

Blood circulates through arteries and veins in and around the cranium. When those vessels become abnormally formed, constricted, or expanded, blood flow becomes uneven and noisy. This is referred to as turbulent flow, and your ear may interpret it as a sound.

Examples of such causes include:

• Narrowing of the arteries in the neck or close to the ear

• Abnormalities in the major veins that carry blood draining from the brain (venous sinus problems)

• A loop of a blood vessel that lies extremely close to the internal ear structures

You are not hearing things in a “psychological” manner when you hear this. You are often hearing actual movement of blood. The sound may resemble water flowing through a hose that contains a kink or a rough section.

While some of these causes are non-threatening, others such as significant constriction or abnormal connection(s) between arterial and venous vessels may increase the risk of stroke or hemorrhage. Imaging studies become critical in this circumstance.

High Blood Flow States And Heart Related Causes

Any condition that increases cardiac output will make pulsatile tinnitus louder.

Examples of such conditions include:

• Hypertension

• Anemia (low red blood cell count)

• Hyperthyroidism (over-activity of the thyroid gland)

• Pregnancy

• Rapid heart rate or specific cardiac disorders

In each of these instances, the body pushes more blood through the same vessels. As a result, a previously silent flow may become audible.

Fortunately, when you address the underlying condition, the pulsation in your ear will generally subside. Managing blood pressure, treating anemia, and addressing hyperthyroidism can reduce the pulsatile tinnitus.

Pressure Changes Around Your Brain And Spine

Your brain is suspended in a fluid-filled cavity. If pressure in that fluid increases, it may compress nearby veins and modify blood flow.

A classic example of this is a condition known as idiopathic intracranial hypertension (also known as pseudotumor cerebri). This is more common among:

• Young women

• Individuals with greater body mass

• Individuals taking specific medication

Potential symptoms may include:

• Pulsatile tinnitus, often bilaterally

• Headaches, particularly when lying down

• Vision disturbances, such as blurred vision or visual flash

• A sensation of a rushing or whirring feeling in the head

This condition is treatable, but requires medical attention to avoid damaging your vision over time.

Ear, Sinus, And Middle Ear Problems That Cause Pulsatile Sounds

At times, the source of the pulsatile tinnitus is situated directly in the ear or immediately behind the eardrum.

Possible causes include:

• Fluid accumulation in the middle ear

• Ear infections

• Eustachian tube dysfunction

• A type of tumor referred to as glomus tumor (paraganglioma), positioned posteriorly to the eardrum

Glomus tumors are typically benign, but they contain a substantial number of blood vessels and thus can generate a pulsating sound in one ear. On occasion, an otolaryngologist/ENT doctor may visually observe a bright red, pulsating mass behind the eardrum during an examination.

Generally, these issues require specialized care from an otolaryngologist/ENT doctor. There are no home remedies available to resolve structural abnormalities in the ear.

Is Pulsatile Tinnitus Dangerous Or A Medical Emergency?

You may find yourself wondering, “Is pulsatile tinnitus hazardous?” The honest response is: occasionally.

Most causes are not life-threatening. Mild hypertension and middle ear fluid, for instance, are rarely problematic and can be addressed without causing lasting harm. However, pulsatile tinnitus can also signify:

• Narrowed or damaged blood vessels

• Abnormal connections between arterial and venous vessels

• Clots in veins that drain blood from the brain

New onset pulsatile tinnitus, particularly in one ear, should always be evaluated. It is imperative to receive prompt attention if you are experiencing:

• Severe or sudden headaches

• Vision disturbances

• Dizziness, weakness, or difficulty articulating words

These symptoms may indicate a stroke or serious brain pressure problems. In such a scenario, do not delay scheduling a routine appointment. Seek immediate medical attention at a hospital emergency department or contact emergency services.

Symptoms, Red Flags, And When To See A Doctor

Pulsatile tinnitus can be confusing. You may wonder if you’re being overly cautious or if you’re going to force your physician to investigate further. Separating common symptoms from true red flags can help.

Your goal is not to frighten yourself. Your objective is to note patterns, document them, and utilize them to acquire the proper assistance.

Common Symptoms You Might Notice With Pulsatile Tinnitus

Individuals often report the following experiences:

• A whooshing, thumping, or heartbeat sound in one ear or both

• A sound that matches your pulse

• Worsens while lying down or bending forward

• Modifies when you apply gentle pressure to your neck, or slightly rotate your head

• Sensation of fullness or pressure in the ear

• Hearing loss, or muffled hearing

• Headaches or sensations of pressure in your head

Take note of:

• What triggers louder pulsations? Stress, physical activity, caffeine, certain postures?

• What diminishes the pulsatility? Gently pressing on your neck, sitting upright, ambient noise?

• When did it begin? Were you experiencing an illness, injury, or major life event at approximately that time?

Documenting your symptoms in a basic symptom journal, even in a mobile device’s notes application, can be beneficial for your physician.

Danger Signs You Should Never Ignore

Some symptoms necessitate that you cease reading immediately and seek medical attention quickly. These include:

• Sudden hearing loss in one ear or both

• Worst headache you have ever experienced

• Double vision or partial vision loss

• Trouble articulating words, slurred speech, or disorientation

• Weakness, numbness, or facial paralysis in one half of the body

• Chest pain, shortness of breath, or loss of consciousness

If any of the above occur in conjunction with pulsatile tinnitus, consider it a medical emergency. It is preferable to be examined and informed that you are fine rather than waiting at home and hoping it resolves itself.

Which Doctors Diagnose Pulsatile Tinnitus

You don’t have to decipher everything yourself. Typically, the diagnosis of pulsatile tinnitus begins with:

• Primary Care Physician: Initial evaluation for most patients. They evaluate blood pressure, basic lab work, and your overall well-being. They decide which specialist to consult.

• Otolaryngologist (ENT): Focuses on the ear, nose, and throat. Evaluates the eardrum, middle ear, and sinuses. Orders audiograms.

• Audiologist: Conducts detailed audiograms. Assists in determining whether you have hearing loss or another ear-related concern.

• Neurologist or Neurosurgeon: Investigates brain and nervous system-related causes, including elevated intracranial pressure and/or irregular blood vessels in the brain.

• Vascular Specialist or Interventional Radiologist: Concentrates on arteries and veins. Examines vascular images and possibly performs procedures, such as stenting or embolization.

You may not require consultation with every one of these physicians. Your primary care physician or ENT will guide you based on your symptoms and test outcomes.

How Pulsatile Tinnitus Is Diagnosed (Tests, Scans, And ICD Codes)

When it comes to a diagnostic pathway for pulsatitie tinnitus, it is a sequential, methodical approach, rather than one large block of testing at one time. With each step in the process answering a new question (e.g., whether or not the sound is caused by the ear, or the blood vessels around the ear), that provides a direction for the next step in the process.

Therefore, using each result to determine what needs to be ruled out, what should be further evaluated and which specialists to involve at the next level of the process, it is not as much of a guessing game as it is a very structured and directed approach to diagnosing pulsatile tinnitus.

You do not need to learn the names of the individual tests or acronyms for each test. Rather, you would benefit from having a basic understanding of what each test is designed to evaluate, and how it could potentially impact your treatment plan.

By understanding why your physician orders specific tests, it can make you more comfortable and able to ask better questions regarding the process, and also allow you to speak up if there is something that doesn’t seem correct.

Your First Visit: History, Ear Exam, And Hearing Tests

Most commonly, your physician will perform the following evaluations and assessments at the initial consultation:

• Ask you to provide your own description of the sound
• Determine when the sound began, and what factors either exacerbate or alleviate the sound
• Assess your previous medical history, including your current medication regimen
• Conduct a physical assessment of your blood pressure, heart rate and general state of health
• Perform an otoscopic examination (using a lighted scope to visualize your ear canal and tympanic membrane).

This is where your symptom diary helps. You can bring:

• A list of your symptoms and when they occur
• A list of your medications and supplements
• Any prior scan or test reports you may have.

The hearing test evaluates your ability to detect various frequencies and tone levels, as well as assesses the functioning of your middle ear. Any abnormalities detected through these tests can lead your physician to suspect middle ear fluid, tumors, or inner ear dysfunction.

Imaging Tests That Look At Blood Vessels And Brain

Depending upon your physician’s clinical suspicion of potential sources of the tinnitus originating from blood vessels or brain structures, he/she may refer you to a radiologist to obtain the following imaging studies:

• Computed Tomography (CT) Scan of the Head or Temporal Bones: Utilizes X-rays to evaluate bone structure, middle ear anatomy and the pattern of blood vessels. Useful in evaluating ear and skull-related disorders.
• Magnetic Resonance Imaging (MRI) of the Brain and Inner Ear: Utilizes magnetic fields and radio waves to generate images of soft tissue, nerves and a wide variety of tumors and pressure changes within the inner ear.
• MR Angiography (MRA) or MR Venography (MRV): Utilize special MRI techniques to evaluate arteries or veins. Are used to evaluate areas of narrowing, thrombosis or abnormal communication between vessels.
• Contrast dye to highlight blood vessels. Provides detailed images of vessel shape and size.
• Ultrasound of Neck Vessels: Utilizes sound waves on the skin of your neck to evaluate blood flow within the carotid and vertebral arteries.

These studies assist in ruling out possible serious causes and identifying treatable causes of your tinnitus. Most of these studies are non-invasive and pain-free; however, some studies utilize contrast dye and may require the insertion of an IV catheter.

Understanding Pulsatile Tinnitus Bilateral ICD 10 And Medical Codes

In your medical bills and/or visit notes, you may encounter unfamiliar coding language. This is referred to as ICD 10 coding. Physicians and insurance companies utilize ICD 10 coding to document patient conditions and track diagnoses.

There are ICD 10 codes for tinnitus in general, codes to identify which ear(s) are affected, and codes to indicate the presence of underlying causative factors (such as high blood pressure, increased intracranial pressure, etc.). If your physician identifies tinnitus affecting both ears, your chart may reflect that you have “pulsatile tinnitus bilateral ICD 10” and other applicable codes.

You do not need to be concerned about these codes. These codes serve primarily for documentation and billing purposes. You can use them to monitor your diagnosis over time, or to request copies of your medical records if you are planning to switch physicians.

Real Treatment Options For Pulsatile Tinnitus That Actually Help

No one treatment option is effective for all patients suffering from pulsatile tinnitus. The optimal treatment option for your condition will be determined by the identified cause of your tinnitus. While this may initially seem confusing or frustrating, there is encouraging news. Once the underlying cause is identified, many patients experience relief from their tinnitus.

Treatment options for pulsatile tinnitus can be categorized into three primary categories.

Treating The Underlying Cause (The Most Important Step)

The best way to manage symptoms associated with pulsatile tinnitus is to address the underlying cause of the tinnitus. Potential treatment options include:

• Controlling High Blood Pressure: Use of medications, dietary adjustments and exercise to maintain blood pressure within a healthy range.
• Addressing Anemia: Use of iron supplements, dietary modifications and treatment of anemia based on the underlying cause.
• Managing Thyroid Disease: Use of medications to decrease hyperthyroidism, or to achieve a balance of hormones.
• Reducing Intracranial Pressure: Use of weight reduction plans, medications to reduce cerebrospinal fluid pressure, or surgery for selected cases of idiopathic intracranial hypertension.
• Correcting Vascular Problems: In select cases, procedures such as stenting narrowed veins or arteries, closing abnormal communications between vessels, or surgical correction/movement of a vessel.

Your physician will create a customized treatment plan for you. The most important thing is to work with qualified specialists and to avoid making claims about quick fixes for your tinnitus, particularly those found on the internet.

Ear And Sinus Treatments That Can Quiet The Pulse

If your physician believes the source of your tinnitus is located in your ear or sinuses, then referrals to an ENT specialist will be made. Various treatment options may be available, depending upon what your physician finds through the exam and imaging studies, including:

• Use of antibiotics to treat bacterial infections of the ear or sinuses
• Use of short-term decongestants or nasal sprays as needed
• Insertion of ear tubes to drain chronic fluid buildup in the middle ear
• Removal of glomus tumors or other masses present in the middle ear

Home Remedies, ear candles and some supplements are not solutions

It is acceptable to utilize gentle comfort measures, such as warm compresses or white noise, while undergoing medical treatment for pulsatile tinnitus. However, home remedies, ear candles or random supplements are not solutions to removing tumors, draining fluid behind the eardrum, etc.

What If No Clear Cause Is Found? Coping And Sound Management

Sometimes, even after conducting all relevant studies, no evident cause of tinnitus is identified. While this can be discouraging, it does not mean that you are destined to live with tinnitus for the remainder of your life.

Regardless of whether or not you can identify a specific cause, you can still implement steps to lower your stress level and improve your quality of life.

• Sound Therapy: Use of soft background sounds at night, such as a fan, nature sounds, or a white-noise machine, can help to mask the pulsing of the tinnitus.
• Masking Apps and Devices: Phone applications or small sound-emitting devices are used by some individuals to cover the tinnitus during the day.
• Cognitive Behavioral Therapy (CBT): A therapist who has received training in treating tinnitus can teach you strategies to modify how your brain responds to the tinnitus. Often, reducing the emotional distress related to tinnitus will help improve your sleep.
• Stress and Sleep Management: Regular meditation and/or deep breathing, establishing a consistent sleep schedule, and practicing gentle movement can lower your overall tension level, which may contribute to reduced tinnitus intensity.
• Tracking Triggers: Identify potential triggers, such as caffeine, alcohol, sugar or irregular sleep patterns, and adjust your lifestyle accordingly to possibly greatly diminish your tinnitus annoyance.

You are not experiencing an illusion. You are finding ways to decrease the power tinnitus has over your daily life.

Conclusion

Pulsatile tinnitus is more than just an irritating sound. It is a signal from your body, sometimes harmless and sometimes serious. Now that you know that pulsatile tinnitus is a rhythmic whooshing that follows your pulse, and it can originate from blood vessels, brain pressure, or ear problems, and proper diagnosis leads to real treatment options.

You don’t have to navigate the unknown or ignore your fears. Your next action is easy. Contact your physician, begin a symptom journal, or book that hearing test you have been putting off. The objective is not to be perfect, it is to gain traction and feel safe.

Using the appropriate information, conducting the right tests and working with the appropriate healthcare providers, many people notice significant improvements in their pulsatile tinnitus, and/or that the tinnitus becomes much less intimidating. You are deserving of clarity, a plan and a more peaceful mind as you continue on your journey.