pulsatile tinnitus

Pulsatile tinnitus is the type of ear noise that is perceived as a rhythmic pulsing that is often in time with the heartbeat. It can be experienced as a thumping or whooshing sound. It is sometimes referred to as vascular tinnitus because in the majority of cases, it is related to disturbances in the blood flow. About 3% of tinnitus patients experience this type of tinnitus.

Pulsatile tinnitus usually originates within the blood vessels inside the head or neck region when disturbed blood flow occurs. This results from either increased blood flow or a narrowing of the opening of the blood vessel, both of which result in turbulent blood flow that can be heard in the ears. In this regard, it is totally different from and independent of continuous tinnitus which results from damage to the cochlea and/or hearing nerve.
1 – Benign Intracranial Hypertension (BIH). This is a condition where there is increased pressure of the cerebrospinal fluid that bathes the brain. The majority of these patients are young females who are generally overweight. Other symptoms of BIH may include hearing loss, ear fullness, dizziness, headaches and visual disturbances. Management of this condition includes weight loss and administration of a diuretic. Most patients improve dramatically with weight reduction alone.

2 – Glomus Tumor. This is a benign vascular tumor usually located in the ear or just below the ear at the skull base. It consists of a mass of intertwined blood vessels. Hearing loss is also a common symptom. Young patients are usually treated surgically, to remove the tumor, while older patients may need no treatment since they are very slow growing.

3 – Atherosclerotic Carotid Artery Disease. Atherosclerosis is the narrowing of the artery due to cholesterol build-up on the artery wall. This reduces the opening resulting in turbulent blood flow that produces pulsatile tinnitus. This usually occurs in older patients with a history of hypertension, elevated cholesterol, diabetes, angina and smoking. The condition can usually be controlled through medication.

4 – Intracranial Vascular Lesions. These include aneurism and arteriovenous malformations, which is an abnormal connection between an artery and a vein.The blood flows directly from a high pressure artery to a lower pressure vein without going through the capillaries. Either aneurism or arteriovenous malformation can lead to bleeding in the brain and can be extremely dangerous. Therapies include surgery and embolizing (closing off) the blood vessels.

5 – Middle Ear Effusion. The middle ear is normally an air-filled space. If fluid accumulates in the middle ear due to infection, inflammation or Eustachian tube dysfunction, pulsatile tinnitus can result. It is sometime accompanied by decreased hearing, a feeling of fullness, and may also include pain. This is most often treated with antibiotics, decongestants, nasal sprays, etc. or sometimes surgery.

6 – Venous Hum. Patients who are pregnant, anemic, or have thyroid problems, may develop increased blood flow through the jugular vein, the largest vein in the neck. The jugular vein traverses the middle ear and any turbulent flow in the vein can be heard in the middle ear as a “hum” which may or may not fluctuate with the pulse. Correction of the underlying problem generally results in improvement or resolution.

7 – Hypertension. There are reports of patients with high blood pressure whose pulsatile tinnitus started after they began taking blood pressure medication. Tinnitus subsided in most after four to six weeks. For the remainder, a change to another medication resolved the issue. Others developed tinnitus from elevated blood pressure and it resolved after medication reduced the pressure.

8 – Twisted Arteries. Twisted arteries in the head and neck cause turbulent blood flow leading to pulsatile tinnitus. It generally does not require treatment.

These are the primary causes of pulsatile tinnitus but not an exhaustive listing.

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