Pulsatile Tinnitus

Pulsatile Tinnitus and Its Symptoms

Pulsatile tinnitus is a particular form of tinnitus that affects around 3% of tinnitus sufferers and falls into the ‘objective tinnitus’ camp.

Tinnitus can be either subjective or objective. ‘Subjective’ is where only the sufferer hears the sounds, and even a physician using a special audio instrument cannot hear them. This is by far the most common form. ‘Objective’ is where both the sufferer and their physician (with a technical aid) can hear the sounds.

It is possible for someone suffering from general ‘continuous’ or ‘steady state’ tinnitus to also suffer from pulsatile tinnitus. They will hear the steady state noises when they are able to reduce their pulsing noises by, for example, pressing down lightly on the vein on their neck. And in some cases it can disappear for some time, leaving just the continuous sounds in their ears, but then return again some hours or so later. And as with general tinnitus, sufferers can have pulsatile tinnitus in one or both ears.

The symptoms of pulsating tinnitus aren’t such things as ringing, hissing, buzzing, etc. These are more your continuous tinnitus. Rather, the pulsatile symptoms are things like whooshing, pounding, throbbing, drumming, swishing, sometimes clicking, ticking even. In other words, not usually continuous.

And as you will see in more detail below, the chief cause of this condition is related to blood circulatory problems, so that should you experience any of the symptoms, you should consult your physician for examination and diagnosis of the underlying problem.

Pulsatile Tinnitus Causes

Pulsatile tinnitus is so named because the sounds that the sufferer hears are rhythmical in nature and oftentimes seem to ‘beat’ in time with the patient’s pulse or heartbeat. This is because the chief underlying cause of this form of tinnitus is turbulent blood flow in the head and neck, called ‘arterial disturbance.’ This is also why pulsatile tinnitus is sometimes called ‘vascular tinnitus.’ Because the blood flow is turbulent it is also ‘noisy,’ particularly so to someone with impaired hearing, which is one of the major causes of tinnitus in general.

A common cause of turbulent blood flow is a constriction in the blood vessels to and from the ears due to, for example, fatty deposits (plaque) in the inner lining or a ‘kink’ or other malformation of the actual blood vessel.

Other possible causes of pulsatile tinnitus are:-

Venous Hum

When blood flow increases through the jugular vein it can become turbulent and so can cause noise as discussed above. This increased blood flow may occur where the patient has, for example, anemia, has thyroid problems, is pregnant, etc.

Glomus Tumor

Don’t worry, this is a benign tumor that may be found in the middle ear or in other sites such as inside the jugular vein and the temporal bone (at the sides and base of the skull). Glomus tumors are more common in the middle ear. The tumor is just a concentrated collection of many blood vessels that are intertwined and so is very sensitive to blood flow. If the tumor actually touches the surface of the eardrum, then it may pulsate in time with the tumor mass.

Atherosclerosis

Put simply, this is narrowing of the arteries due to a build-up of cholestorol in the inner walls of the arteries. As discussed previously, this causes turbulent blood flow and hence pulsating tinnitus.

Hypertension (High Blood Pressure)

High blood pressure leads to faster-flowing blood through the blood vessels thus creating turbulence and hence pulsatile tinnitus sounds. Medication to reduce hypertension can help. Sometimes, though, patients have reported that their pulsating tinnitus didn’t actually start until they had been taking medication to lower their hypertension. In other words the drugs were probably the cause of it. Most of these reported that their tinnitus reduced after several weeks. Others managed to get a reduction after changing their medication in consultation with their physician.

Benign Intracranial Hypertension

BIH is the term for the situation where there is increased pressure in the fluid that surrounds the brain. It is often accompanied by dizziness, loss of balance, blurred vision, headaches, a feeling of internal pressure, and hearing loss. And it also causes tinnitus. It mostly affects women, but can also affect men and children. It can be caused by issues such as being overweight, hormonal problems, menstrual problems, and some medications such as oral contraceptive pills.

Middle Ear Effusion

The middle ear is internal to the eardrum, is pea-sized and filled with air. It contains the three small ear bones, termed ‘hammer,’ ‘anvil’ and ‘stirrup,’ that are attached to the inside of the ear drum. When the ear drum vibrates due to incoming acoustic pressure waves (external sound), the middle ear — via the three tiny bones — converts and tranfers these pressure wave vibrations into fluid membrane waves within the cochlea, situated in the inner ear.

But should any fluid manage to get into the middle ear cavity, this can cause pulsatile tinnitus; one of the reasons being that it is often accompanied by hearing loss and increased internal pressure. Fluid can accumulate in the middle ear due to things like ear infections and Eustacian tube blockage which ‘backs-up’ fluid into the middle ear.

Twisted Arteries in the Head and Neck

Arteries in the head and neck can become ‘twisted,’ and just as twisting a rubber tube for instance leads to kinks and reduced cross section, the same goes for twisted arteries. This then leads to turbulent blood flow causing the pulsing noises associated with pulsatile tinnitus.

Intracranial Vascular Lesions

In simple terms this is where there is an abnormal connection between the artery and the vein. This connection is normally through tiny capilleries. But in the case of IVL the irregular connection is directly between the two, so that the high pressure arterial blood flows directly into the low pressure veins, without first going through the capilleries where certain important processes take place. Often tinnitus is an outcome of this condition. But there are other even more serious problems that can occur such as bleeding in the brain. Which is yet another reason why you should consult your physician if you suffer the symptoms of pulsating or tinnitus in general.

Pulsatile Tinnitus Summary

Pulsatile tinnitus is an objective tinnitus.
Its symptoms are sounds such as whooshing, swishing, pounding, clicking, etc., that are rhythmical rather than continuous, often in time with the heartbeat.
Patients can suffer both pulsatile tinnitus and continuous tinnitus at the same time.
There are quite a few causes but, in general tems, the main cause is circulatory.
It is important therefore to consult your physician if you show signs of pulsatile tinnitus.