Pulsatile Tinnitus: Causes, Symptoms, And Treatment

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Key takeaway

Pulsatile tinnitus is a rhythmic pulsing sound in the ear that beats in time with the heartbeat, often caused by changes in blood flow in the head or neck. Unlike other forms of tinnitus, pulsatile tinnitus has a physical source.
Several conditions can cause pulsatile tinnitus, including increased blood flow (from exercise, anemia, or an overactive thyroid), tumors, atherosclerosis, hearing loss, and intracranial hypertension.
Treatment options for pulsatile tinnitus range from addressing the underlying cause to self-management techniques like sound therapy, relaxation methods, cognitive behavioral therapy, and tinnitus retraining therapy.

Some people hear sounds similar to music or singing.

Pulsatile tinnitus is characterized by hearing noises that beat in time with your pulse.

What is pulsatile tinnitus?

Woman checking her pulse by placing two fingers on her wrist. — A pulse is the rhythm of blood being pumped around the body. It can be checked by placing two fingers on the wrist.

Pulsatile tinnitus is a rhythmical noise that beats at the same rate as the heart and is the sound of blood circulating the body. A person can confirm this by feeling their pulse as they listen to the tinnitus noise.

Unlike other forms of tinnitus, which are thought to be caused by a disconnect between the sounds the ears hear and the way the brain interprets them, pulsatile tinnitus has a physical source.

Causes

Pulsatile tinnitus occurs when the ear becomes aware of a change in blood flow in nearby blood vessels. These include the arteries and veins in the neck, base of the skull, and in the ear itself.

The main causes are:

Generalised increased blood flow

When blood is flowing quickly, such as during strenuous exercise or pregnancy, it makes more noise.

Severe anemia or an overactive thyroid gland may also cause general increased blood flow in the body.

Localised increased flow

Sometimes, blood flow increases in just one or one group of vessels. Tumors in the head and neck can lead to the development of abnormal blood vessels, which can result in pulsatile tinnitus.

The majority of tumors associated with pulsatile tinnitus are benign, meaning they are not cancerous.

Turbulent blood flow

Atherosclerosis, or hardening of the arteries, makes the insides of the blood vessels lumpy. This leads to a turbulent and louder blood flow.

Heightened awareness

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A heightened awareness of sound may be caused by injuries or disorders in the ear. This could lead to pulsatile tinnitus.

If someone is suffering from a condition causing conductive hearing loss, such as a perforated eardrum or secretory otitis media (glue ear), they tend to be more aware of sounds from inside their body.

People can also experience a heightened sensitivity in their auditory pathways, meaning the brain is alerted to normal noises in the blood vessels that it would usually ignore.

Intracranial hypertension

A condition called benign or idiopathic intracranial hypertension can cause pulsatile tinnitus, as well as headaches and sight problems.

It is unclear what causes the condition, but young and middle-aged women who are overweight are most at risk.

Diagnosis

To diagnose tinnitus, a doctor will ask questions such as whether the sound is continuous, if it affects one or both ears, and what kind of impact it is having on a person’s everyday life.

They will also ask whether a person has experienced any other symptoms of hearing loss or has been taking medications that list tinnitus as a side effect.

They will examine the inside and outside of the ear to check for problems that might be easy to treat, such as an infection or excess earwax.

A specialist will examine the eyes, head, and neck, and do a hearing test.

In people with pulsatile tinnitus, doctors may suggest that they have additional tests, such as an MRI or ultrasound scan, to study the blood vessels and check the pressure inside the head.

Treatment

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Sound enrichment or therapy may help to ease the symptoms of tinnitus.

If a specific cause is found for pulsatile tinnitus, doctors can treat the underlying condition.

Anemia can be treated with medication or blood transfusions. Secretory otitis media may be treated with a tympanostomy tube, or grommet. Perforated eardrums can be closed with grafts, and narrowed segments of an artery can be repaired.

If caused by a specific blood vessel, doctors may or may not be able to repair it, depending on where the vessel is located.

If there are no medical interventions, a person can try several self-management techniques, including:

Sound therapy

Sound therapy, also called sound enrichment, was originally developed as a form of distraction. Many people with tinnitus notice their symptoms more when in a quiet environment, so listening to other sounds can make them less intrusive.

Sound therapy is the deliberate use of any sound to reduce a person’s awareness of tinnitus. A person could try listening to:

environmental noise, such as from an open window
music or the radio
a dedicated smartphone App
table-top sound generators
a wearable sound generator

Relaxation

Certain changes take place in the body when a person relaxes, including a drop in their heart rate, blood pressure, and some brain activity.

Relaxation techniques, such as breathing exercises, mindfulness, and meditation, may also reduce the impact pulsatile tinnitus can have on everyday life.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) aims to change the way people react to their tinnitus rather than remove the actual sounds. The idea is to learn techniques to improve the way a person thinks about and acts towards the tinnitus.

Tinnitus retraining therapy

Tinnitus retraining therapy (TRT) is a form of therapy that aims to help people manage the impact tinnitus has on their everyday life. TRT uses directive counseling and sound therapy.

Outlook

Many of the underlying causes of pulsatile tinnitus are treatable, but it is important to see a doctor for a proper diagnosis.

Untreated pulsatile tinnitus can have a negative impact on a person’s quality of life, but there are many different self-management approaches that can help reduce symptoms.

Cardiovascular / Cardiology
Hearing / Deafness
Neurology / Neuroscience

How we reviewed this article:

SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Jun, H. J., & Park, M. K. (2013, December 13). Cognitive behavioral therapy for tinnitus: Evidence and efficacy. Korean Journal of Audiology, 17(3), 101–104http://ejao.org/journal/view.php?doi=10.7874/kja.2013.17.3.101
Pulsatile tinnitus. (n.d.)https://www.tinnitus.org.uk/pulsatile-tinnitus
Relaxation. (n.d.)https://www.tinnitus.org.uk/relaxation
Sound therapy. (n.d.)https://www.tinnitus.org.uk/sound-therapy
Tinnitus. (2012, October)http://american-hearing.org/disorders/tinnitus/
Tinnitus. (2015, June 26)http://www.nhs.uk/Conditions/Tinnitus/Pages/Diagnosis.aspx
Tinnitus retraining therapy. (2017, January 27)https://www.tinnitus.org.uk/faqs/tinnitus-retraining-therapy-trt

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Medically reviewed by Suzanne Falck, M.D., FACP — Written by Amanda Barrell — Updated on June 26, 2023

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Key takeaway

What is pulsatile tinnitus?

Causes

Diagnosis

Treatment

Outlook

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