Pulsatile tinnitus: causes and treatments

What is pulsatile tinnitus?

Tinnitus is a perception of sounds that is generated by the nervous system of the ear and brain in the absence of any external sound source. It is usually heard only by the individual experiencing tinnitus and is commonly described as a ringing in the ear, buzzing or humming. On the other hand, Pulsatile tinnitus is often described as a thumping or whooshing sound in the ear that has a like a rhythmic pulsing that is often in time with the person’s heartbeat. This is also referred to as vascular tinnitus as in many cases the cause is related to changes in blood flow.You can identify if your tinnitus is pulsatile simply by feeling your pulse and listening to see if your tinnitus is in sync. It is not considered to be pulsatile or vascular tinnitus when the rhythm is not in synchrony with the heartbeat. This type of tinnitus is usually caused by rhythmical contraction of muscles in the middle ear.It is thought that 3% of tinnitus sufferers experience pulsatile or vascular tinnitus. It is also very possible to experience both pulsatile tinnitus and another form of tinnitus at the same time, although pulsatile tinnitus is often reported as the most intrusive.Pulsatile tinnitus, just like other forms of tinnitus, can be experienced momentarily or as a constant noise which tends to be steady without regular changes in frequency or volume.

Causes of pulsatile tinnitus

As with all cases of tinnitus, it is very difficult and rare to identify a single underlying cause of pulsatile tinnitus. The chances of finding a cause of pulsatile tinnitus are greater than with non-rhythmic because it is easier to identify as a change in the persons blood flow, but finding one single cause is still difficult and rare. The most common cause of pulsatile tinnitus is thought to be related to a blood flow disturbance in the vessels close to the ear, or a change in the persons awareness of that blood flow. The blood vessels include the large arteries and veins in the neck and base of the skull, as well as the smaller one in the ear itself. The blood flow can be disturbed by a variety of factors:

Generalised increased blood flow

An increase in the speed of blood flow throughout the body, which tends to make more noise than a slow blood flow. This can be temporarily caused through strenuous exercise or pregnancy, or it can be caused more consistently by other problems such as anaemia or an overactive thyroid gland.

Localised increased blood flow

An increase in blood flow in a single blood vessel or a group of blood vessels, often near to the ear, can result in pulsatile tinnitus. This can be caused by abnormal blood vessels, sometimes caused by benign tumours (not usually malignant tumours) in the head or neck, or even blood vessels developed during foetal development which usually close before birth but sometimes persist.

Turbulent blood flow

Blood flow inside a vessel can sometimes be turbulent rather than smooth due to blocked or hardened arteries. This will seem noisy as the blood moves more rapidly, just as it would in a river rapid or waterfall. This usually occurs in older people with a medical history of angina, smoking, diabetes, hypertension or elevated cholesterol, and can be managed with medication.

Increased awareness of blood flow

A persons awareness of the noise can be altered for different reasons. Hearing loss can sometimes make a person more aware of sounds inside their body which have previously been blocked out by the volume of external sounds. Alternatively, an increased sensitivity in the auditory pathways can alert the brain the sound of blood vessels, similar to the way non-rhythmic tinnitus is experienced.

Middle Ear Effusion

If fluid builds up in the middle ear due to infection, inflammation or Eustachian tube dysfunction, pulsatile tinnitus may be experienced. This can be helped by a range of treatments, such as antibiotics, decongestants and nasal sprays.

Unexplained reasons

There are still many cases of pulsatile tinnitus which do not fit into any of these categories. A condition called benign or idiopathic intracranial hypertension is sometimes experienced, mostly by overweight young women, where pulsatile tinnitus is experienced, but the cause of this condition is unknown. Most patients find that weight reduction improves the condition dramatically. This is certainly not an exhaustive list of the causes of pulsatile tinnitus and anyone experiencing it should seek professional help from a doctor or audiologist.

How serious is pulsatile tinnitus?

As the cause of pulsatile tinnitus can really differ from person to person, it can be difficult to generalise how serious pulsatile tinnitus is.  In terms of danger to health, pulsatile tinnitus is most often not going to be considered too serious.  However, it most certainly will feel serious for the person experiencing it day to day, and it can have serious impacts on mental health longer term.   We would always advise anyone experiencing tinnitus of any kind to seek professional help

Pulsatile tinnitus treatments

It is possible to find a treatment or cure for pulsatile tinnitus in the rare cases of the cause being found. In some cases, such as when the cause is identified as anaemia, medication can be prescribed which should lessen the experience of pulsatile tinnitus. Unfortunately, in many cases it is so difficult to pinpoint a specific cause that a treatment usually cannot be prescribed. In other cases, the single cause can be identified fairly confidently but is too difficult to provide a treatment, such as when a single blood vessel is the cause. In these examples, the tinnitus would be managed in much the same way as other forms of tinnitus, looking at sound therapy, relaxation therapy, mindfulness & meditation and counselling.

Will pulsatile tinnitus go away?

If the correct cause and treatment for someone’s pulsatile tinnitus can be found, then it may well go away.   In the more likely event that we cannot pinpoint a cause , pulsatile tinnitus can be treated in the same way we would manage other forms of tinnitus.  The purpose of mindfulness,  meditation, sound therapy and counselling is to learn ways to manage tinnitus in order to notice it less, and reduce any associated stress.  We have been using these methods of treatment for hearing loss and tinnitus sufferers for many years and with great success, learn more about our CALM programme.If you are experiencing pulsatile tinnitus or any other form of tinnitus, get in touch with Cubex to speak with one of our audiologists