Pulsatile tinnitus is a rare form of tinnitus characterized by a whooshing or thumping sound either in one or both ears. The ringing in the ear often follows a steady beat, and in most cases, it is in tune with the patient's pulse. This is why it is also known as vascular, rhythmic, or pulse-synchronous tinnitus.

Unlike other tinnitus types, where the tinnitus noise is heard by only the patient because there is no actual cause of the noise, pulsatile is different. The source of the noise is inside the patient's body, and in most cases, a doctor will be able to hear the noise if he listens with a stethoscope.

The source of this noise is often traced to an increase in blood turbulence near the ear, increased awareness of blood flow in the ear, or altered blood flow in the ear.

Pulsatile tinnitus noise is annoying to many people who have it, and in some cases, the noise is often loud, intense, and distracting, making it hard for the patient to sleep or concentrate.

Unlike other types of tinnitus, pulsatile tinnitus has an identifiable source. The presence of pulsatile tinnitus is an indication that there is a serious underlying medical condition.

Even though this may sound scary, the good news is that most of the underlying causes can be treated, and once the underlying cause is treated, the tinnitus will disappear. What this means is that in most cases, pulsatile tinnitus is not permanent.

Symptoms of Pulsatile Tinnitus

Just like every other type of tinnitus, pulsatile tinnitus is accompanied by some symptoms. The severity of the symptoms may vary from person to person. If you have pulsatile tinnitus, below are some common symptoms you will experience:

• Whooshing or Thumping Sound: This is the major indicator that your tinnitus is pulsatile. You will regularly hear a thumping or whooshing sound that is in sync with your pulse. The sound always has a rhythm and can be heard in one or both of your ears.
  
  Usually, when your heartbeat rate increases, the tinnitus noise will increase, and when the heartbeat rate is low, the tinnitus noise reduces.

• Headaches: The constant thumping sound in your head may cause headaches occasionally.
  
  
• Dizziness and Vision Problems: Occasional bouts of dizziness and difficulty with vision are often experienced by people with pulsatile tinnitus. If you have idiopathic intracranial hypertension (high pressure in the fluid around the brain), you may experience more bouts of dizziness.
  
  
• Difficulty to Sleep or Concentrate: If you have pulsatile tinnitus, you may notice that it gets worse or louder when you lay down. This makes it difficult for you to sleep, especially at night when it is quiet. You will also have difficulty concentrating when reading or working.

• Hearing Loss: Pulsatile tinnitus can degenerate to hearing loss if the underlying problem is responsible for not getting the required medical attention promptly. Depending on the cause and the degree of damage done, hearing loss may be temporary or permanent.

Pulsatile Tinnitus Causes

Unlike regular tinnitus, the cause of pulsatile tinnitus can often be identified after a few medical examinations.

The causes of tinnitus are categorized into two: vascular causes and non-vascular causes.

Pulsatile tinnitus is said to be of vascular origin is caused by a problem in the vascular system. Vascular causes are subcategorized into venous causes and arterial causes. Arterial factors are the most common causes of pulsatile tinnitus.

Non-vascular causes are causes that are not related to the vascular system.

Let's examine some common causes of pulsatile tinnitus. As we examine each cause, you will be able to identify the vascular and nonvascular causes.

1. Atherosclerosis

Atherosclerosis, also referred to as atherosclerotic cardiovascular disease, is the hardening of the arteries in the body, which is often caused by an accumulation of cholesterol, plaque, and other fat clogs in the arteries.

Arteries are flexible, and they have enough room for blood to flow in them freely without you noticing the movement, but when the arteries get clogged or blocked, the blood flow to parts of the body, including the ear, head, and neck are affected.

Arteries have a thin layer of cells in them known as the endothelium, which is responsible for keeping the inside of the arteries smooth and in shape to ensure continuous blood flow.

Atherosclerosis often begins when the endothelium is damaged.
Damage to the endothelium is caused by high blood pressure, inflammation from lupus or arthritis, high cholesterol, obesity, smoking, or diabetes.

The damage to the endothelium gives room for bad cholesterol to enter your arteries’ walls, which causes the body to release white blood cells into the arteries to try to digest the cholesterol. But over time, the white blood cells and cholesterol turn to plaque and begin to build up along the walls of the arteries.

The accumulated plaque begins to form bumps on the walls of the artery, and the bumps continue to grow until they form a blockage.

This blockage begins to choke the flow of blood through the arteries, and in some cases, the blockage can rupture. This causes blood to clot inside the artery where the rupture happened, which can cause a heart attack or a stroke.

The formation of plaque blockage in your arteries makes the arteries lose their flexibility and makes blood flowing near the middle and inner ear move with more force. This forceful flow of blood creates a sound that can be heard in both ears. The sound of forceful blood flow being heard is pulsatile tinnitus.

Aside from pulsatile tinnitus, other atherosclerosis symptoms are; pain in the upper body, shortness of breath, unusual heartbeat, difficulty speaking and understanding speech, severe headache, drooping facial muscles, and paralysis.

2. Hyperactive Thyroid Gland or Hyperthyroidism

This is a non-vascular cause of pulsatile tinnitus. It is a condition that affects the thyroid gland, which is located in front of the neck. It is characterized by weight loss, prominent eyes, irregular menstrual cycle, and goiter.

The thyroid gland is responsible for the production of triiodothyronine(T3) and tetraiodothyronine(T4). These two hormones regulate how the cells in your body use energy. The release of these hormones helps to regulate your metabolism.

Hyperthyroidism occurs when your thyroid gland begins to produce too much T4 or T3. The most common cause of Hyperthyroidism is an autoimmune disease known as Graves disease. The disease triggers antibodies to stimulate the thyroid gland to secrete too much of each hormone.

Hyperthyroidism can be caused by other factors such as benign tumors or the pituitary gland or thyroid, inflammation of the thyroid, excess iodine, and ovaries and testes’ tumors.

The presence of high amounts of T4 and T3 can skyrocket your body’s metabolic rate, which causes you to experience hand tremors, rapid heart rate, and increased blood pressure. The increase in the blood pressure causes blood to rush through your veins with more force, and this can cause pulsatile tinnitus.

3. Irregular Blood Vessels

Most pulsatile tinnitus cases can be linked to the presence of irregular blood vessels in the body, especially in the head.

Blood vessels can get kinked or damaged by various factors. When the blood vessels affected are around the ear, the flow of blood in them will cause you to hear pulsatile tinnitus sounds.

The affected blood vessel can be a vein or an artery. The carotid artery and the jugular vein are the two blood vessels in the head that their deformity can cause tinnitus. The blood vessels’ damage causes a change of pressure in the blood vessel and generates audible noise.

Health conditions like high blood pressure can change the flow of blood through blood vessels. Alcohol, caffeine, and stress can also amplify the noise and make it more noticeable.

4. Ear Abnormalities

Certain abnormalities in the ear, like superior semicircular canal dehiscence syndrome, which is a disease that affects the superior semicircular canal in the inner ear, can cause pulsatile tinnitus.

The superior semicircular canal dehiscence syndrome occurs when part of the temporal bone overlying the superior semicircular canal is missing or abnormally thin.

Also, ear abnormalities that cause a thinning or missing of the bone overlying the major veins and arteries that run near the ear can cause you to hear your heartbeat, resulting in pulsatile tinnitus.

5. Sinus Wall Abnormalities

Abnormalities of the sinus wall, such as the sigmoid sinus diverticulum can cause pulsatile tinnitus. The sigmoid sinus is a channel that carries blood located on the side of the brain, where blood is received from veins within the brain.

Sigmoid sinus diverticulum is said to occur when small pouches known as diverticula begin to form. These pouches protrude through the wall of the sigmoid sinus and enter the mastoid bone behind the ear.

Dehiscence is the absence of a part of the bone that surrounds the sigmoid sinus in the mastoid.

Both sigmoid sinus diverticulum and dehiscence cause a change in blood flow and the flow’s pressure and noise. Because this ear’s location is very close to the ear, the pressure change will result in pulsatile tinnitus.

6. Idiopathic Intracranial Hypertension

This is a medical condition that occurs when there is high pressure around the brain. The high pressure causes symptoms like headache, tinnitus, blind spots, double vision, neck and shoulder pain, and temporary blindness.

There is fluid around the brain and spinal cord, which is known as the Cerebrospinal fluid (CSF). When the fluid begins to build up in the skull, it puts extra pressure on the optic nerve and the brain.

It is referred to as idiopathic intracranial hypertension because the exact cause of the pressure is not known.
The extra pressure on the brain and the optic nerve causes you to develop pulsatile tinnitus, amongst other symptoms already mentioned.

Idiopathic Intracranial Hypertension can be treated with certain medications, through surgery or weight loss. Once it is handled, the pulsatile tinnitus will disappear.

7. Head and Neck Tumors

The growth of tumors in the head or neck can pressure the blood vessels in that region and cause pulsatile tinnitus.

For instance, Glomus tumors, which are often common in parts of the jugular vein below the middle ear, can cause tinnitus. Although benign, this tumor is locally invasive.

The tumors are highly vascular, and their presence close to the ear can cause pulsatile tinnitus because of the amount of pressure they place on the blood vessels in the head and neck.

8. Other Causes

Asides from the seven causes of pulsatile tinnitus we have examined above, here are some additional factors that can cause tinnitus: Paget's disease, head trauma, conductive hearing loss, and high blood pressure.

Conclusion

Pulsatile tinnitus should not be overlooked because it is always a warning that something is wrong with your health.

Though discomforting, pulsatile tinnitus is often temporal, as once the underlying cause is treated, the ringing will fade away. But remember that prompt medical attention is key.

Have you had pulsatile tinnitus in the past? What caused it?

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