What Is the Most Common Cause of Pulsatile Tinnitus?

What is Pulsatile Tinnitus?

If you can hear your heartbeat in your ear, you may be experiencing pulsatile tinnitus, a unique form of tinnitus. Unlike the constant ringing or buzzing most people associate with tinnitus, pulsatile tinnitus creates a rhythmic, pulsing, or whooshing sound that is often in sync with your heartbeat.

This pulsing sound can be soft or loud, intermittent or constant. It might be heard in both ears, but it’s often more noticeable in just one. In fact, pulsatile tinnitus in one ear only is common—and may offer clues to its underlying cause.

So, what is the most common cause of pulsatile tinnitus? Let’s explore.

What Is the Most Common Cause of Pulsatile Tinnitus?

The most common cause of pulsatile tinnitus is turbulent blood flow in nearby blood vessels—particularly those located in the head and neck. As blood flows through arteries and veins near the ear, especially the jugular vein and carotid artery, irregularities in flow or structure can create an audible sound that the brain interprets as pulsing or throbbing.

This turbulence can be due to:

• High blood pressure
• Narrowed arteries
• Twisting or kinking blood vessels
• Vascular malformations, such as arteriovenous malformations (AVMs)

These changes in flow can amplify the sound of blood moving past the inner ear structures, making it possible to hear your pulse beating in your ears.

Pulsatile Tinnitus Causes: Beyond Vascular Flow

1. Idiopathic Intracranial Hypertension (IIH)

This condition, sometimes called pseudotumor cerebri, involves elevated pressure inside the skull without a clear cause. It’s especially common in young women and can cause headaches, vision changes, and pulsatile tinnitus symptoms due to pressure on the auditory nerves or nearby blood vessels.

2. Venous Sinus Stenosis

A narrowing in the venous drainage system of the brain can alter blood flow and create a pulsing sound.

3. Tumors in the Head and Neck

Though rare, certain tumors (such as glomus tumors) can develop near the ear canal or middle ear and press against nearby blood vessels, resulting in pulsatile tinnitus.

4. Conductive Hearing Loss

Conditions like fluid buildup, ear infections, or ear bone disorders can reduce ambient sounds and make internal body sounds, like your heartbeat in your ear, more noticeable

Pulsatile Tinnitus Symptoms: What Should You Look For?

• A rhythmic sound in the ear that matches your heartbeat
• Throbbing or whooshing noise
• Sound heard in one ear only
• Pulsing that’s louder at night or when lying down
• Hearing loss or muffled sounds
• Headaches, dizziness, or visual changes (especially in IIH)

You may also notice that you hear sound more intensely in quiet environments—or that using white noise helps mask the sensation.

How Is Pulsatile Tinnitus Diagnosed?

Diagnosing pulsatile tinnitus often begins with a thorough medical history and physical exam, followed by specialized testing:

• Hearing test to check for hearing loss
• CT scan, MRI, or MRA to examine the blood vessels, jugular vein, and carotid artery
• Venography to look for venous narrowing
• Blood pressure check and metabolic panel to rule out systemic issues
• Neurological exam to assess for IIH or other intracranial conditions

In many cases, imaging reveals structural or vascular abnormalities that explain the sound in your ears.

Is It Dangerous to Hear Your Pulse in Your Ears?

Hearing your pulse beating in your ears can be unsettling, but it’s not always a sign of danger. Still, it’s important not to ignore it. Some vascular causes—like arteriovenous malformations or venous sinus stenosis—may require medical or surgical treatment to prevent long-term complications.

Other causes, such as high blood pressure or idiopathic intracranial hypertension, can be managed with medication, lifestyle changes, or minimally invasive procedures.

In rare cases, the cause of pulsatile tinnitus may be unknown. This is referred to as idiopathic pulsatile tinnitus. Even when a cause isn’t found, symptoms can often be managed effectively.

Treatment Options for Pulsatile Tinnitus

1. Sound Generators and Maskers
   Sound therapy can be beneficial, especially when tinnitus is stress-related. Devices called sound generators produce calming sounds to mask tinnitus. White noise machines, apps, and hearing aids with masking features are popular options that can make tinnitus less disruptive.
2. Hearing Tests and Medical Evaluation
   Seeing a specialist for a hearing test and possibly imaging tests can help identify any treatable causes, especially if pulsatile tinnitus is related to blood vessels or the ear canal. If the source of the tinnitus is structural or vascular, addressing the root cause might relieve symptoms.
3. Stress and Anxiety Management
   Since stress can worsen pulsatile tinnitus, learning to manage anxiety is key. Techniques like meditation, breathing exercises, and counseling can help. Mental health support may be especially helpful for breaking the feedback loop of anxiety and tinnitus.
4. Lifestyle Adjustments
   Changes like reducing caffeine intake, avoiding loud noise exposure, and managing blood pressure can reduce the impact of pulsatile tinnitus. Regular physical activity and adequate hydration can also contribute to better vascular health, potentially reducing the intensity of the pulsating sound.
5. Medications and Therapies
   Some patients benefit from medications aimed at controlling blood pressure or relaxing the muscles around the ear. Middle ear myoclonus (MEM), for example, is a rare condition involving spasms of tiny muscles (tensor tympani and stapedius) in the middle ear, which can create a rhythmic noise. Medications or botulinum toxin injections may be recommended if muscle spasms are the cause.
6. Neurointervention
   This procedure is typically recommended when pulsatile tinnitus is linked to venous sinus stenosis—a narrowing of the venous channels that drain blood from the brain. By placing a stent within the narrowed venous sinus, blood flow is restored, relieving the turbulent blood flow that causes the pulsatile sound. For many, this results in a significant reduction or even elimination of symptoms. Venous sinus stenting offers hope for patients with otherwise difficult-to-treat pulsatile tinnitus, providing relief from this often life-disrupting condition.

Treatment Options for Pulsatile Tinnitus

Once the cause is identified, treatment focuses on addressing the root of the problem. Common approaches include:

1. Managing Blood Pressure

If hypertension is contributing to turbulent blood flow, medications and lifestyle adjustments can ease symptoms.

2. Intervention for Vascular Abnormalities

Procedures like venous stenting or embolization may be used to correct flow abnormalities or narrowings in veins and arteries.

3. Sound Therapy

Sound therapy, often using white noise machines or masking devices, can help the brain tune out the pulsing sensation.

4. Treating Intracranial Pressure

For patients with idiopathic intracranial hypertension, weight loss, diuretics, or shunting procedures may help normalize pressure and reduce pulsatile tinnitus symptoms.

5. Hearing Aids

When hearing loss is present, hearing aids can improve ambient sound levels and reduce awareness of internal pulsing.

Final Thoughts: Don’t Ignore Pulsatile Tinnitus

If you hear your heartbeat in your ear or feel like your ear is in sync with your heart’s beating, it’s not something to brush off. While the most common cause of pulsatile tinnitus is usually a vascular issue, only a full medical evaluation can determine what’s going on.

At Neurosurgeons of New Jersey, we bring specialized expertise in diagnosing and treating vascular causes of tinnitus—including hard-to-detect conditions that impact the blood vessels of the head and neck. Whether through advanced imaging or minimally invasive treatment, relief is possible.

If you’ve been asking, “What is the most common cause of pulsatile tinnitus?” the answer is more than just curiosity—it’s the key to getting your peace and quiet back.