Pulsatile Tinnitus: What Causes a Rhythmic Sound in Your Ears?

Most tinnitus is a steady ringing, buzzing, or hissing. But some people hear a rhythmic whooshing or thumping that keeps time with their heartbeat. This is called pulsatile tinnitus, and it is different enough that it deserves its own explanation.

How it differs from regular tinnitus

Ordinary tinnitus is usually caused by changes in the hearing system itself, often after noise exposure or hearing loss. Pulsatile tinnitus is usually caused by blood flow: you are hearing turbulent or increased blood flow in vessels near the ear. It makes up a small share of all tinnitus cases.

The good news is that pulsatile tinnitus more often has a specific, identifiable cause, and some of those causes are treatable. The important news is that it should always be evaluated by a doctor, because a few causes need medical attention.

Common causes

• Increased blood flow. Anemia, an overactive thyroid, pregnancy, fever, or intense exercise can make blood flow faster and louder.
• High blood pressure. Higher pressure can make blood flow near the ear more noticeable.
• Middle ear problems. Fluid behind the eardrum, infection, inflammation, or a blocked Eustachian tube can make you more aware of your own blood flow.
• Idiopathic intracranial hypertension. Raised pressure around the brain, often with headaches and vision changes, is a well-known cause, especially in younger women.
• Narrowing or irregularities in veins or arteries. This includes narrowing of the carotid artery or of the large veins that drain the brain.

Less common causes

• Glomus tumors (paragangliomas). Slow-growing, usually non-cancerous tumors near the middle ear that are rich in blood vessels.
• Arteriovenous malformations or fistulas. Abnormal connections between arteries and veins. A carotid-cavernous fistula, for example, can follow a serious head injury and is usually treated with a minimally invasive procedure through the blood vessels.

How it is diagnosed

Your doctor will ask about your symptoms, listen around your ear and neck with a stethoscope, and check your hearing. Depending on what they find, you may have blood tests or imaging such as an ultrasound, CT, or MRI scan.

When to get help quickly

See a doctor promptly for any new pulsatile tinnitus. Get urgent care if it comes with a sudden severe headache, changes in vision, weakness, numbness, confusion, or trouble speaking.

Treatment

Treatment depends on the cause. Treating anemia or a thyroid problem, lowering blood pressure, clearing middle ear fluid, or treating raised pressure around the brain can reduce or end the sound. If no cause is found, the same sound therapy and coping strategies used for regular tinnitus can help make it less bothersome.