What is pulsatile tinnitus?
Pulsatile tinnitus is a rhythmical noise in the ears that is similar to the sound of a person's pulse or heartbeat. This sound may come and go and may be quite distracting to some people. In most cases, pulsatile tinnitus is related to blood flow disturbances, which is why this symptom is also sometimes called as vascular tinnitus. This type of tinnitus occurs in approximately 3 percent of tinnitus patients.
Causes of Pulsatile Tinnitus
People with pulsatile tinnitus often hear rhythmic thumping, whooshing, or throbbing in one ear. However, some also hear these sounds in both ears. Pulsatile tinnitus is an amplified sound of a change in the flow of blood near your ears or in your ears. Altered blood flow can be caused by the following factors:
1. Increase in Blood Flow (Generalized)
Blood that quickly flows usually sound louder than a slow flow of blood. Pregnancy and vigorous physical activities can increase a person's blood flow throughout the body. Other conditions that can cause an increased blood flow in the body include:
2. Increase in Blood Flow (Localized)
Blood flow in a single or group of blood vessels can also increase sometimes. An example would be the flow of blood adjacent to the structures of the middle ear, which can create sounds like pulsatile tinnitus. The development of abnormal blood vessels due to head and neck tumors can also result in pulsatile tinnitus. However, most tumors that are related to pulsatile tinnitus are often benign.
3. Turbulent Flow of Blood
The flow of blood becomes turbulent rather than smooth when a person has atherosclerosis or the hardening of the arteries. Plaque builds up inside the arteries in people with atherosclerosis. Plaque is made up of cholesterol, fat, calcium and other substances in the blood. When plaque hardens, it narrows the arteries and limits the flow of blood to the body resulting in a turbulent flow of blood and pulsatile tinnitus.
Atherosclerosis usually occurs in elderly patients with a history of the following:
4. Benign Intracranial Hypertension (BIH)
In BIH, there is an increased pressure around the brain without the presence of a tumor. Most patients who develop this condition are overweight females of childbearing age. The symptoms of BIH may include:
This condition can be managed by the administration of diuretics and weight loss. Majority of the patients tend to improve with weight loss alone.
- Arnold-Chiari malformation (structural defects in the cerebellum)
- Hyperthyroidism (overproduction of hormones in the thyroid gland)
- Iron deficiency
- Anything that increases blood flow
- Soft palate spasms in people with multiple sclerosis and other degenerative neurological disorders
People with pulsatile tinnitus regularly hear sounds that are similar to the sound of their heartbeat or pulse. For most people, this sound can be quite distracting and loud, and even unbearable at times.
Those who have high pressure in the cerebrospinal fluid around their brain (idiopathic intracranial hypertension) may also have the following symptoms:
- Loss of hearing
- Vision problems
People who have pulsatile tinnitus may need to see an otolaryngologist (ear specialist). The doctor will check the patient's ears along with performing a hearing test. The patient's eyes may also be checked to look for any signs of increased pressure in the brain.
Other tests that might be included are:
- Ultrasound - The flow of blood within the blood vessels of the neck can be shown with the help of a Doppler.
- Magnetic Resonance Imaging (MRI) - Images of the head and inner ear can be produced using magnetic fields. With an MRI, some conditions are shown better.
- Magnetic Resonance Angiography (MRA) - Images of the inside of the arteries or veins can be produced using an MRA. Any narrowing of the vessel and irregularities can also be shown in this imaging test.
- Computerized Tomography (CT) Scan - Detailed images of the body can be created by using computer controlled X-rays.
- Computerized Tomographic Angiography - It is possible to obtain images of the inside of the blood vessels by using a contrast medium and showing it up on X-rays and then doing a CT scan.
- Angiography - This imaging test involves the injection of a contrast medium into the blood vessel to look at the inside of the vessel. Clearer and more detailed images of the vessels are produced in an angiography.
Blood tests may also be requested in some cases to rule out other causes of pulsatile tinnitus.
- Complete Blood Count (CBC) - To rule out anemia.
- Thyroid Function Tests - To check the functioning of the thyroid gland.
The doctor may also ask for the opinion of other specialists, such as neurologists or ophthalmologists, who may also request other specialized tests, if benign intracranial hypertension is suspected.
Individuals who regularly experience pulsatile tinnitus can have poor sleep, which often leads to:
- Low energy levels
- Poor concentration
- Heart problems
- Weight gain
- Metabolic issues
The underlying cause of pulsatile tinnitus needs to be first diagnosed for proper treatment. If the underlying cause is anemia, treatment may include medications, blood transfusion, or both. If the main cause of pulsatile tinnitus is an overactive thyroid gland, certain medications can be prescribed.
If a perforated eardrum is causing the condition, the perforation first needs to be closed by utilizing grafts. Narrowed and hardened arteries also need to be repaired to ensure a smooth flow of blood instead of a turbulent one.
Vein and artery conditions including high blood pressure are often treated with certain lifestyle changes and medications:
- Regular exercise
- Smoking cessation
- Managing stress
- Consuming a low-sodium diet
The following therapies may also be helpful in cases that have an unidentifiable cause:
- Relaxation techniques
- Cognitive behavioral therapy
Other alternative therapies may include:
- White Noise - There are special machines that can create white noise, which can help make pulsatile tinnitus less noticeable, particularly at bedtime. The sound of an air conditioner or fan may also help. Downloadable white noise is also available in some mobile apps.
- Wearable Sound Generators - These devices look similar to hearing aids, and can create low background noise.
- Tinnitus Retraining Therapy- This is a tinnitus management approach, which can help people learn how to cope with tinnitus on both conscious and subconscious levels.