Objective tinnitus is the perception of sound in the ear without an external source. This noise can, however, be heard by a doctor when they use a stethoscope.
Objective tinnitus can be caused by problems with bones in the middle ear, vascular deformities, or involuntary muscle contractions. This condition is uncommon. Thankfully, it’s usually treatable by correcting the mechanical or vascular cause.
The examiner can hear the noise generated by structures near the ear that the objective tinnitus sufferer hears. Most tinnitus is subjective, which means only the patient perceives the sounds. Objective tinnitus is different.
What Is Objective Tinnitus?
Medical experts also call objective tinnitus pulsatile or rhythmic tinnitus. The sounds the patient hears are pulses, and they relate to your heartbeat or blood moving through arteries.
Objective tinnitus often moves in rhythm with your heartbeat. Pulsatile tinnitus noise sounds like a whooshing or thumping noise.
Since the noise is in sync with your heartbeat, the noise in your ear will increase when your heartbeat increases. When your heartbeat reduces, the noise in your ear reduces.
Pulsatile tinnitus may be benign and simply annoy the tinnitus patient, but it can also be severe and so debilitating that regular activities like sleeping and concentrating are affected.
The causes of objective tinnitus fall into categories according to their origin:
Arterial (relating to the arteries)
Arteriovenous (related to arteries and veins)
Venous (associated with the network of veins that carry blood to your heart from your organs)
Pulsatile tinnitus noise may come and go, or it may be constant. It can also disappear on its own without any treatment. It is, however, essential to visit a doctor when you notice this type of ringing because it may be a symptom of a dangerous health condition that can cause severe damage or death if left untreated.
The Difference Between Objective and Subjective Tinnitus
Objective tinnitus is the opposite of subjective tinnitus; while the symptoms may be the same, subjective tinnitus is only heard by the tinnitus patient. The doctor won’t hear the noise even when a stethoscope is placed over the subjective tinnitus patient’s ear.
As we know, objective tinnitus is a rarer kind of tinnitus, but it has an identifiable cause that’s usually treatable. This is different from subjective tinnitus, which is often idiopathic and incurable.
Causes of Objective Tinnitus
Objective tinnitus is often caused by diseases, abnormalities, or disorders, including Susac syndrome, atherosclerosis, and sinus wall abnormalities.
Let's examine the causes of objective tinnitus in detail.
Susac syndrome is a rare autoimmune disease that makes your immune system attack the smallest blood vessels in your inner ear, brain, and retina. Susac syndrome is also known as Small Infractions of the Cochlear, Retinal, and Encephalic Tissue (SICRET).
Even though the immune system begins to attack tiny blood vessels, the major victims are the endothelium’s endothelial cells.
These cells play a vital part in ensuring the growth, repair, and cleaning up blood vessels. When the endothelial cells are attacked, they swell up. This swelling can entirely or partially stop blood flow through the affected vessel.
This blockage of blood flow prevents oxygen and the required nutrients from getting to the part of the body being serviced by the blood vessel.
Inner ear symptoms of Susac syndrome include tinnitus, hearing loss, and dizziness or vertigo.
Atherosclerosis, also known as atherosclerotic cardiovascular disease, is the hardening or narrowing of arteries caused by damage to the endothelium. The endothelium is the thin membrane that lines the interior of blood vessels and the heart.
Bad cholesterol can enter the arteries ‘ walls without the endothelium filtering what gets into the blood vessels. The cholesterol is digested by the white blood cells, and over time, the digested cholesterol and the cells form plaque blockages on the wall of arteries.
With the blockage of the arteries, blood flow becomes more forceful and turbulent. This turbulent blood flow is heard as objective tinnitus, which is why it is in sync with your pulse.
Head or Neck Tumors
Acoustic neuroma (vestibular schwannoma) is a slow-growing tumor on the main nerve connecting the inner ear to the brain. The vestibular nerve branches play an active part in hearing and balance. Common symptoms of acoustic neuroma are sudden or gradual hearing loss, vertigo, tinnitus, facial weakness, and muscle weakness.
Glomus tumors (paragangliomas) are benign but locally invasive in the blood vessels in the head and neck. If the tumor is located in the middle ear, it is referred to as a glomus tympanum tumor. Common symptoms of this glomus tumor include pulsatile ringing in the ear, bleeding from one ear, and hearing loss.
Turbulent Blood Flow
Fibromuscular dysplasia is a rare cause of objective tinnitus. It is a medical condition that causes stenosis (narrowing) and aneurysms (enlargement) of medium-sized arteries in the body.
The carotid artery is the artery leading to the brain. When it is affected, it can cause temporary loss of vision, headache, neck pain, facial weakness, difficulty speaking, dizziness, pulsating ringing in the ear, neck pain, and numbness in the limbs.
Sinus Wall Abnormalities
Sigmoid sinus diverticulum and dehiscence are the common sinus wall abnormalities that cause objective tinnitus. The sigmoid sinus is located on the side of the brain, and it is a channel that receives blood from veins in the brain.
The sigmoid sinus diverticulum occurs when small pouches that protrude through the sigmoid sinus wall located behind the ear in the mastoid bone are formed. These pouches interfere with the normal flow of blood within the affected area.
On the other hand, Dehiscence is the absence of a bone part that surrounds the sigmoid sinus in the mastoid behind the ear.
Both sigmoid sinus diverticulum and dehiscence cause a change in pressure, noise, and blood flow in the sigmoid sinus. In some cases, the blood vessel leading to the sigmoid sinus can also be damaged. This change in the blood pressure and flow causes the flow to become noisy. This noise is what is perceived as objective tinnitus.
Other causes of objective tinnitus include:
Superior Semicircular Canal Dehiscence Syndrome: This condition occurs when the temporal bone that overlies the superior semicircular canal is too thin or absent. The superior semicircular canal is found in the vestibular apparatus in the inner ear, which is responsible for hearing and balance. The absence of this thin bone can cause objective tinnitus and balance problems.
Abnormal Capillaries: The abnormal formation of capillaries can affect the flow of blood and cause objective tinnitus.
Idiopathic Intracranial Hypertension: This buildup of cerebrospinal fluid in the head can increase the head’s pressure and cause symptoms like double vision, headaches, and tinnitus.
High-Blood Pressure: When your blood pressure is high, blood flow through the carotid artery becomes turbulent and louder than normal. High blood pressure can either cause or aggravate objective tinnitus.
Patulous Eustachian Tubes: This is a condition in which the typically closed Eustachian tubes are abnormally open. This opening causes vibrations to be sent directly to the eardrum when chewing, talking, or swallowing. This can result in objective tinnitus.
Symptoms of Objective Tinnitus
Tinnitus isn’t considered a medical condition; rather, it is a symptom of another underlying condition. Just like every other symptom, tinnitus always has a root cause. This means that the presence of tinnitus is a sign that something is wrong.
This, however, doesn’t mean that the tinnitus noise is the only thing you’ll feel if you have tinnitus. Other symptoms often accompany it. The symptoms may result from tinnitus, but others may stem from the exact underlying cause.
Symptoms of tinnitus include:
The perception of sound or noise in the ear.
Difficulty understanding speech
Insomnia or difficulty sleeping
Also, the severity of the tinnitus noise and its effects on the tinnitus patient’s life varies from patient to patient. No two cases of tinnitus are ever considered the same.
Treatment for Objective Tinnitus
There’s no cure for tinnitus yet, but objective tinnitus can be cured or improved by identifying and treating the primary underlying cause.
High blood pressure, vein conditions, and artery conditions are often treated with medication and lifestyle changes like:
Surgery or a catheter procedure can correct problems in arteries or veins. A stent in a blocked artery opens it up and improves blood flow. Tumors would be removed by surgery.
If the source of the tinnitus isn’t identified, you may have to undergo Tinnitus Retraining Therapy or make use of masking devices such as hearing aids.
This is rarely the case because the cause of objective tinnitus is often known, and there are appropriate treatments available to either cure or manage the underlying cause.
In most cases, tinnitus doesn’t just affect your hearing; it can spill into other aspects of your health. In cases where tinnitus did severe damage due to delay of medical care, death may occur.
If you notice ringing in your ears, don't hesitate to inform your doctor. Even though the causes of objective tinnitus can be identified and handled, the damages may be permanent if they aren’t given prompt medical attention.
“Even in the most difficult to treat cases of tinnitus, ENT doctors are often able to help manage patient’s symptoms effectively.” - Drew Sutton, MD, Board-Certified Otolaryngologist.
Drew Sutton M.D.
Drew Sutton, MD is a board-certified otolaryngologist. He has extensive experience and training in sinus and respiratory diseases, ear and skull base surgery, and pulmonary disorders. He has served as a Clinical Instructor at Grady Hospital Emory University for more than 12 years.