Pulsatile Tinnitus: Symptoms, Causes & Treatment

Pulsatile tinnitus is a type of tinnitus in which a person hears a rhythmic sound that often matches the heartbeat. It may feel like a whooshing, pulsing, throbbing, or beating noise in one or both ears.

Pulsatile Tinnitus can happen when blood flow near the ear becomes louder, faster, or more turbulent. It can also happen when the ear becomes more sensitive to normal blood flow sounds in the head and neck.

Treatment depends on the cause. A doctor may recommend monitoring, imaging tests, medication, procedures, or surgery, especially if the sound is new, one-sided, getting worse, or linked to other symptoms.

Main symptoms

Common symptoms of pulsatile tinnitus include:

• A pulsing, whooshing, thumping, or beating sound in the ear

• A sound that matches the heartbeat

• Noise in one ear or both ears

• Symptoms that become more noticeable at night or in quiet places

• Sound that changes when turning the head, lying down, or pressing gently on the neck

• Hearing changes or a feeling of fullness in the ear

• Headache, vision changes, dizziness, or balance problems in some cases

Pulsatile tinnitus should be assessed by a doctor, as it can sometimes be linked to blood vessel changes, increased pressure around the brain, or tumors in the ear or head and neck area.

Possible causes

Pulsatile tinnitus is usually caused by changes in blood flow or sound transmission near the ear. In many cases, the cause is related to arteries, veins, or increased pressure around the brain.

• Venous sinus stenosis: Narrowing of a large vein that drains blood from the brain can cause turbulent blood flow and a pulse-like sound.
• Sigmoid sinus wall abnormalities: Thin or missing bone near a vein close to the inner ear can make normal blood flow sounds easier to hear.
• Dural arteriovenous fistula: An abnormal connection between an artery and a vein near the brain can cause fast, turbulent blood flow.
• Arteriovenous malformation: A tangle of abnormal blood vessels can change normal blood flow and lead to rhythmic ear noise.
• Carotid artery disease: Narrowing, plaque buildup, or injury in the neck arteries can create turbulent blood flow that may be heard in the ear.
• Glomus tumors: These blood vessel-rich tumors can develop in or near the middle ear and cause a pulsing sound.
• Idiopathic intracranial hypertension: Increased pressure around the brain can cause pulsatile tinnitus, often with headaches or vision changes.
• Conductive hearing loss: Earwax, middle ear fluid, eardrum problems, or changes in the small ear bones can make internal body sounds seem louder.

Identifying the cause is important, as some causes are harmless while others may need urgent medical treatment.

Confirming a diagnosis

Diagnosis starts with a medical history and physical exam. A doctor may ask when the sound started, whether it affects one or both ears, if it matches the heartbeat, and whether it changes with head movement, exercise, or pressure on the neck.

The doctor may examine the ears and listen with a stethoscope around the ear, neck, and skull to check for abnormal blood flow sounds. Hearing tests are often used to check for hearing loss or middle ear problems.

Imaging is commonly needed to confirm the cause. Tests may include MRI, MRA, MRV, CT, CTA, ultrasound, or catheter angiography, depending on the suspected cause and exam findings.

Treatment options

Treatment for pulsatile tinnitus depends on the underlying cause. Some people need only monitoring, while others need medication, procedures, or surgery.

1. Monitoring and reassurance

If no dangerous cause is found and symptoms are mild, the doctor may recommend observation. Follow-up may be needed to check whether symptoms change or worsen.

Some people may benefit from education, sound therapy, relaxation strategies, or tinnitus retraining therapy. These approaches do not treat the cause, but they may help reduce distress when no correctable cause is found.

2. Treating blood pressure and blood flow problems

If high blood pressure or vascular risk factors are contributing to symptoms, treatment may include blood pressure control and management of cholesterol, diabetes, or smoking. These steps can help reduce strain on blood vessels.

Carotid artery disease or other arterial problems may need medication or procedures. The best approach depends on the type and severity of the blood vessel change.

3. Treatment for idiopathic intracranial hypertension

Treatment may include weight management, medication to reduce fluid pressure, and regular eye checks. Vision symptoms need careful monitoring because this condition can affect the optic nerve.

Some cases may require procedures, such as venous sinus stenting or surgery to protect vision. Treatment is usually guided by neurology, ophthalmology, neurosurgery, or interventional radiology specialists.

4. Endovascular procedures

Endovascular treatment is performed through blood vessels using small tubes called catheters. It may be used for conditions such as dural arteriovenous fistulas, venous sinus stenosis, or some vascular malformations.

The goal is to repair abnormal blood flow and reduce the pulsing sound. The exact procedure depends on the location and type of blood vessel problem.

5. Surgery

Surgery may be recommended for some tumors, sigmoid sinus wall abnormalities, or middle ear causes. It may also be used when a structural problem is clearly linked to symptoms.

The risks and benefits depend on the cause, the person’s health, and the location of the abnormality. A specialist can help decide whether surgery is the safest option.

6. Hearing and tinnitus therapies

If pulsatile tinnitus continues after treatment, or if no treatable cause is found, hearing care may help. Options can include hearing aids, sound therapy, counseling, cognitive behavioral therapy, or tinnitus retraining therapy.

These treatments may help reduce the impact of tinnitus on sleep, concentration, and quality of life. They are often used together with treatment of any medical cause.

When to see a doctor

Medical evaluation is recommended for pulsatile tinnitus, especially when the sound is new, one-sided, constant, or getting worse. A doctor should also assess symptoms that happen with hearing loss, dizziness, headache, vision changes, weakness, numbness, or balance problems.

Urgent care may be needed if pulsatile tinnitus starts suddenly with severe headache, stroke-like symptoms, sudden hearing loss, fainting, or new vision problems. These symptoms can point to conditions that need fast treatment.