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  • Writer's pictureWidex Emirates Hearing Care

Pulsatile Tinnitus: Causes and Treatment

pulsatile tinnitus
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Imagine hearing your heartbeat in your ear. When your ear listens to your heart, this is pulsatile tinnitus.

Pulsatile tinnitus is a rare type of tinnitus, characterized by hearing noises that bear in time with the heart pulse. This article debates the mystery of pulsatile tinnitus, its symptoms, causes, and treatment options.

What is Pulsatile Tinnitus?

Tinnitus, a common hearing impairment, is diagnosed as pulsatile or non-pulsatile. It is the perception of noises in the head and ear that only you can hear. It is often referred to as ‘ringing in the ear’, although many other sounds are heard from clicking to roaring, hissing, whistling, and buzzing.

Pulsatile tinnitus is a rare condition that affects a very small percentage of the estimated people who have tinnitus. Less than 10% of affected people with tinnitus are diagnosed with pulsatile tinnitus.

People with pulsatile tinnitus often hear whooshing, rhythmic thumping, or throbbing in one or both ears. These noises can be loud or soft but often happen in time with their own heartbeats. Like regular tinnitus, you hear a constant sound that others do not hear. The only thing different is that you hear the noise from inside your body.

It usually differs from the more common tinnitus that we know. It has an identifiable source and might be from the first signs of a more serious underlying condition. It is not a condition, but rather a symptom of other disorders. The chances of finding a specific cause are more likely than regular tinnitus, though it is still considered difficult.

Symptoms of Pulsatile Tinnitus

The most common symptom all patients suffer from is regularly hearing a steady beat or whooshing sound. This sound is often in synch with the patient’s heartbeats because when their heart rate accelerates, the sound becomes faster and when it decreases, the sound slows down. The blood pulses faster than normal through a variety of arteries and veins located near the ears. This beat might come and go, or it might stay constant.

You might think that it is very common to hear our heartbeats, but in pulsatile tinnitus, they hear it even when no extra effort is made.

Pulsatile tinnitus symptoms may be more noticeable at night when lying in bed because there are fewer external sounds that can help mask the beat or sound.

You might also notice some other symptoms if you have high blood pressure in the fluid surrounding your brain:

Causes of Pulsatile Tinnitus

In many cases, we can pinpoint the underlying problem behind pulsatile tinnitus. It is frequently caused by a change in blood flow in the vessels near the ear. Some of the causes might be:

  • Atherosclerosis

This is the case when plaque builds up inside the arteries and hardens. When this happens, it narrows the arteries and limits the blood flow to your body, including in your neck, ears, and head. This causes you to hear the rhythmic thumping in one or both of your ears.

  • Blood vessel disorders and malformations

Disorders and malformations in the arteries and blood vessels, especially those close to the ears could be a reason for pulsatile tinnitus. A narrow neck artery or vein can also cause the sound of pulsatile tinnitus.

  • Ear abnormalities

Missing or thinning bones overlying the main veins and arteries near the ear might lead sometimes the patients to hear their heartbeats.

  • High blood pressure (hypertension)

When your blood pressure is high, the blood flow through the arteries is more likely to be turbulent. This might be a reason that causes pulsating sound. Stress, caffeine, and alcohol might also be a reason to make the sound more noticeable.

  • Anemia

It may increase the blood flow, which may affect the blood vessels and cause pulsatile tinnitus. Severe anemia or an overactive thyroid gland can make the blood flow quickly and loudly.

Diagnosis of Pulsatile Tinnitus

To investigate pulsatile tinnitus, a medical appointment is usually required by the doctor to take a detailed history of the tinnitus, followed by an examination of the eardrums and the blood vessels of the neck. You may need to see an otolaryngologist, or an ear specialist, who will perform a hearing test to check your ears. They will also check your eyes for signs of increased pressure in the brain.

Whenever you suspect you have pulsatile tinnitus, your healthcare provider can:

  • Start using a stethoscope, which is the same device put in your chest to hear your heartbeat. They will be able to determine if the pulsatile tinnitus is happening in time with your heartbeat.

If they were able to hear the pulsatile noise through the stethoscope, then it would be considered to be objective pulsatile tinnitus. If they were not able to hear it, then it is considered a subjective pulsatile tinnitus.

  • Test your hearing. They may use tympanometry, a special test that measures the pulsing in your ears to check if it aligns with your pulse.

  • Request different imaging tests.

  1. Angiography: using X-rays to examine your blood vessels

  2. Magnetic Resonance Angiography (MRA): checking for problems with blood vessels in the neck and head

  3. Magnetic Resonance Imaging (MRI): using radio waves to obtain images of tissues within your neck and ears.

  4. Doppler Ultrasound: checking if the blood is flowing through the blood vessels in the neck.

  5. Computed Tomographic (CT): using a computer to take cross-sectional images of the body

  6. Computed Tomographic Angiography (CTA): combining the CT scan with a contrast material that produces pictures of blood vessels and tissues of the body

Effects of Pulsatile Tinnitus

Around 60% of patients who experience pulsatile tinnitus suffer from some form of anxiety and depression. Pulsatile tinnitus might interrupt your ability to concentrate, sleep, or work. It has very similar effects to tinnitus. It can cause sleeping problems, which lead to:

  • Difficulty concentrating

  • Low energy

  • Cardiovascular problems

  • Weight gain

Treatment of Pulsatile Tinnitus

To treat pulsatile tinnitus, we should first identify and treat it. You may need medication or certain surgeries to repair the blood vessels. Once the condition causing it is cured, the sound should stop.

For instance, if you have pulsatile tinnitus due to atherosclerosis, you can use medication to manage it. This medication might eliminate or reduce the sounds of your heart beating in your ear.

If you still hear the noise and no specific treatment is stopping it, then you can try some possible interventions for pulsatile tinnitus:

  • Sound generators

These devices deliver sounds to the ears that mask both tinnitus and pulsatile tinnitus. Such sounds can be soothing ones like quiet rain or showers. They look like hearing aids, creating constant and low-level background noise.

  • Hearing aids

The use of hearing aids with tinnitus programs helps a lot with pulsatile tinnitus. These devices aid in hearing what outside sounds we choose to hear and mask tinnitus.

Any hearing aid supporting tinnitus relief can be used to manage the symptoms of tinnitus. Behind-the-ear and in-the-ear hearing aid models are among the types to choose from. With a properly fit hearing aid, listening becomes easier and stress is reduced.

  • White noise

It can help a lot with making the sound less noticeable, mainly at night. You can buy a special machine that makes it or use certain smartphone apps that make white noise.

  • Environmental enrichment devices

Tabletop sound machines that produce soothing background noise, nature, and other sounds for smartphones and tablets can ease tinnitus symptoms and make them less noticeable.

  • Relaxation techniques

The incessant sound of your heartbeat might be stressful and frustrating. Learning techniques on how to increase relaxation and lessen stress can help you deal with all this frustration and stress.

  • Counseling options

There are certain therapies that people can benefit from because they help them adapt to their new situation and pay less attention to the noises in their heads. Some are Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT).

Changing your lifestyle and using medications can treat pulsatile tinnitus. Regardless of the type of tinnitus you are facing, there is help! Contact your healthcare provider immediately. The faster you seek treatment, the better you can lead a normal life.


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