What Is Pulsatile Tinnitus?

If you hear a steady rhythmic thumping, throbbing, creaking or whooshing sound in one or both ears, you may have pulsatile tinnitus, which is a rare form of tinnitus affecting approximately 5 million people in the United Stated. It is also called pulse-synchronous, rhythmic, or vascular tinnitus, reflecting that the sound is often in synch with the patient’s heartbeat, becoming louder and faster when one’s heart rate increases and softer and less noticeable when it decreases. It is typically indicative of a vascular issue, not a problem with the ear itself.

It is often more noticeable at night while lying in bed because there is less background sound. Like the more common form of tinnitus, which is typically constant, pulsatile tinnitus can interfere with daily activities, making it hard to concentrate, sleep, or work.

A hallmark of pulsatile tinnitus is that it can sometimes be heard by a physician using a stethoscope. Identifying and treating the underlying cause, which may be benign or potentially serious, may reduce or eliminate the sound so undergoing a thorough medical evaluation with an otolaryngologist familiar with the condition is critical. Due to the complexity of the disorder, you may also need to see a neurologist, ophthalmologist, or cardiologist.

Some of the causes of pulsatile tinnitus include:

1. Atherosclerosis, which refers to hardening of the arteries. When plaque builds up and hardens, it reduces the blood flow through the body, including the ears, neck and head. This may cause the rhythmic whooshing or thumping sound in one or both ears.

2. Blood vessel and artery disorders or malformations, especially near the ear. These include aneurysms and arteriovenous malformations.

3. Ear abnormalities

4. Sinus wall abnormalities

5. Head and neck tumors

6. High blood pressure

7. Idiopathic intracranial hypertension, which can cause headaches, blurred vision, and pulsatile tinnitus

8. Anemia

9. Head trauma

10. Conductive hearing loss

11. Hyperthyroidism

12. Paget’s Disease

Imaging procedures to diagnose pulsatile tinnitus may include an angiography, magnetic resonance angiography (MRA), magnetic resonance imaging (MRI), ultrasound, and temporal bone computerized tomography (CT) scan. Blood tests and thyroid function test may be ordered to rule out anemia and hyperthyroidism.

If no underlying cause is found, then coping tools used for tinnitus self-management are recommended, including sound therapy, lifestyle adjustments to reduce stress, and cognitive behavioral therapy. 

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