Pulsatile (pulsating) tinnitus

Have you ever felt like your head and heart are pulsing in time? Pulsatile tinnitus is a specific type of tinnitus characterised by hearing rhythmic sounds in the ear that coincide with the heartbeat and falls into the category of objective tinnitus. This means the noise you hear is actually produced by a physical sound source: the passage of blood through the blood vessels.

The intensity and frequency of the pulsations can vary from person to person and may be more noticeable in quiet environments or when lying down. Pulsatile tinnitus can affect one or both ears.

Pulsatile tinnitus is distinct from regular tinnitus in both the sound perceived and its causes. Regular tinnitus presents as constant ringing or buzzing, while pulsatile tinnitus involves rhythmic pulsations or whooshing noises synchronised with the heartbeat. 

This type of tinnitus is often linked to vascular issues like atherosclerosis, high blood pressure, or arteriovenous malformations near the ear. Diagnosis involves specific imaging studies to assess vascular health. Treatment targets the underlying vascular or muscular issues, which may include managing hypertension or surgical interventions. Recognising these differences is key for accurate diagnosis and effective management tailored to the specific type of tinnitus.

Whilst today pulsatile tinnitus (literally pulse-related) is understood not to be a disease in itself, it is however a symptomatic disorder and its causes therefore require medical diagnosis. Although impossible to generalize, circulatory problems of vascular or venous origin, likewise high blood pressure or the presence of cholesterol plaques, are some of the most common causes of pulsatile tinnitus. Similarly, noise pollution (in particular listening to music with earphones), earwax arising from prolonged antibiotic or diuretic therapies and head and neck injuries may also favour its onset.

Anxiety, stress and psychological shock can also give rise to phenomena of hearing the pulse or heartbeat in the ear. Indeed, anxiety can lead to a reduction of the oxygen supply in the inner ear and create pulsing, buzzing and whooshing sounds. The resulting (parasitic) sound is then detected as an alarm signal by the brain. The close relationship between pulsatile tinnitus and anxiety is a vicious circle which, although not necessarily an immediate health risk in itself, when intense and continuous, can cause insomnia, irritability and concentration disorders.

Identifying pulsatile tinnitus involves recognising specific symptoms:

• Rhythmic sound: pulsatile tinnitus produces rhythmic noises that synchronise with your heartbeat, such as pulsing, throbbing, or whooshing sounds in one or both ears.
• Association with heartbeat: the sound is often likened to hearing your heartbeat inside your ear and may be more noticeable during periods of increased blood flow.
• Intermittent nature: pulsatile tinnitus can come and go throughout the day or over time, rather than being constant like other types of tinnitus.

If you experience these symptoms, it's important to consult an ear specialist for evaluation. They can conduct tests to determine the underlying cause and recommend appropriate treatment.

Diagnosing pulsatile tinnitus involves a series of steps:

• Medical history: your healthcare provider will ask about your symptoms, medical history, and medications.
• Physical examination: a thorough exam of your ears, head, neck, and cardiovascular system will be performed.
• Hearing tests: audiological evaluations to assess hearing function and rule out other ear-related issues.
• Imaging studies: MRI or CT scans may be done to visualize the structures inside your head and ears.
• Vascular studies: Doppler ultrasound or magnetic resonance angiography (MRA) to evaluate blood flow and identify vascular issues.
• Specialist consultation: referral to specialists like neurologists or vascular surgeons for further evaluation if needed.

These steps help determine the underlying cause of pulsatile tinnitus, allowing for appropriate treatment recommendations. 

If your tinnitus is pulsating (you can hear your heartbeat in your ear) or you experience hearing loss, vertigo or dizziness, it is usually recommended you seek medical advice. You can also have a free consultation with a tinnitus specialist at Amplifon to evaluate whether you should see a doctor. 

Anxiety issues, stress and psychological shock aside, the causes of pulsatile tinnitus are usually easily treatable. By treating hypertension, atherosclerosis, benign intracranial hypertension or hyperthyroidism, a significant decrease or, indeed, complete elimination of pulsing in the ear will be noted.

Sometimes, however, surgery will be required to effectively stop pulsing in the ear. This may be a de-clogging procedure to blood flow to re-circulate or, in the case of an abnormal blood vessel, an embolization to block it off. As with all conditions potentially requiring surgery, it is strongly advised you consult an ENT specialist to correctly identify the origin of your symptoms and the best approach to treat them.

During your consultation, the ENT specialist will indicate the most appropriate course of treatment to stop the pulsing in your ear, thereby improving both your hearing and quality of life. Sound enrichment therapy, which sees the use of specific acoustic devices to produce different masking and relaxation signals through melodies and sounds chosen by the user, may also prove an effective pulsatile tinnitus treatment.

Lastly, adopting a healthy lifestyle with a diet rich in fruit and vegetables and introducing foods containing high amounts of vitamins A, B, E, zinc and magnesium, coupled with a moderate consumption of coffee, tea and alcohol, are all excellent ways to improve overall health and reduce or stop pulsing in the ear with home remedies. 

Living with pulsatile tinnitus can be challenging, but there are coping strategies and resources available to help manage the condition effectively.

Coping strategies:

• Sound therapy: using background noise or white noise machines can help mask the pulsatile sounds and provide relief from the perception of tinnitus.
• Relaxation techniques: practicing relaxation methods such as deep breathing, meditation, or yoga can reduce stress and anxiety associated with tinnitus.
• Healthy lifestyle choices: maintaining a balanced diet, regular exercise, and adequate sleep can contribute to overall well-being and may help alleviate tinnitus symptoms.
• Avoiding triggers: identify and avoid factors that worsen tinnitus, such as exposure to loud noises, caffeine, or nicotine.
• Cognitive behavioral therapy (CBT): counseling with a therapist trained in CBT can assist in changing negative thought patterns and improving coping mechanisms for tinnitus.

It's essential to experiment with various coping strategies and seek professional guidance to find what works best for managing pulsatile tinnitus.  If you're struggling to cope with pulsatile tinnitus, don't hesitate to reach out to healthcare providers or support networks for assistance and guidance tailored to your needs.