Pulsatile tinnitus is a rare form of tinnitus that manifests as a whooshing or throbbing sound in one or both ears. This sound usually follows a regular rhythm and, in most cases, is synchronized with the patient's pulse. This is why it is also referred to as vascular, rhythmic, or pulsatile tinnitus. Unlike other types of tinnitus, where only the patient perceives the sound because it has no real source, pulsatile tinnitus is distinctly different. The sound originates from within the patient's body, and in most cases, a doctor can hear it by auscultating with a stethoscope. Its origin is often linked to increased blood turbulence near the ear, an increased perception of blood circulation in the ear, or a change in this blood flow. The sound of pulsatile tinnitus is very bothersome for many affected individuals, and in some cases, it is loud, intense, and distracting, to the point of preventing the patient from sleeping or concentrating. Unlike other forms of tinnitus, pulsatile tinnitus has an identifiable cause. Its presence signals the existence of a serious underlying health problem. This may seem concerning, but the good news is that most of these underlying causes are treatable, and once the cause is addressed, the tinnitus disappears. In other words, in the majority of cases, pulsatile tinnitus is not permanent.
Symptoms of Pulsatile Tinnitus
Like all other forms of tinnitus, pulsatile tinnitus is accompanied by certain symptoms, the severity of which varies from person to person. If you suffer from pulsatile tinnitus, here are the most common symptoms you may experience:
A whooshing or throbbing sound: This is the main indication that your tinnitus is pulsatile. You regularly hear a throbbing or whooshing sound synchronized with your pulse. This sound always follows a rhythm and can be perceived in one or both ears. Generally, when your heart rate increases, the tinnitus sound intensifies; when it decreases, the sound subsides.
Headaches: The constant throbbing in your head can cause occasional headaches.
Dizziness and visual disturbances: People suffering from pulsatile tinnitus often experience episodes of dizziness and visual difficulties. If you have idiopathic intracranial hypertension (high pressure of the fluid surrounding the brain), you are likely to experience more frequent dizziness.
Difficulty sleeping or concentrating: If you suffer from pulsatile tinnitus, you may notice that it worsens or becomes louder when lying down. This makes falling asleep difficult, especially in the evening when everything is quiet. You will also find it difficult to concentrate on reading or working.
Hearing loss: Pulsatile tinnitus can progress to hearing loss if the underlying problem is not medically managed in time. Depending on the cause and extent of the damage, this hearing loss can be temporary or permanent.
Causes of Pulsatile Tinnitus
Unlike conventional tinnitus, the cause of pulsatile tinnitus can often be identified after some medical examinations. These causes fall into two categories: vascular causes and non-vascular causes. Pulsatile tinnitus of vascular origin is when it is caused by a problem with the vascular system. Vascular causes are further subdivided into venous and arterial causes. Arterial factors are the most common causes of pulsatile tinnitus. Non-vascular causes, on the other hand, are unrelated to the vascular system. Let's now examine some common causes of pulsatile tinnitus. Through this examination, you will be able to identify both vascular and non-vascular causes.
1. Atherosclerosis
Atherosclerosis, also known as atherosclerotic cardiovascular disease, refers to the hardening of the body's arteries, often caused by the accumulation of cholesterol, plaque, and other fatty deposits in the arteries. Arteries are flexible and allow enough space for blood to flow freely, without you perceiving this movement. But when they become blocked or obstructed, the blood supply to certain parts of the body, including the ear, head, and neck, is affected. Arteries are lined with a thin layer of cells called the endothelium, which is responsible for keeping the inside of the arteries smooth and in good condition to ensure continuous blood flow. Atherosclerosis often begins with an injury to the endothelium. This injury can be caused by high blood pressure, inflammation related to lupus or arthritis, high cholesterol, obesity, smoking, or diabetes. Endothelial damage allows bad cholesterol to enter the wall of your arteries, prompting the body to release white blood cells to try to digest this cholesterol. But over time, white blood cells and cholesterol turn into plaque that builds up along the arterial walls. This plaque gradually forms ridges on the artery wall, which continue to grow until they create an obstruction. This blockage eventually restricts blood flow in the arteries and, in some cases, it can rupture. This causes a clot to form at the site of the rupture, which can lead to a heart attack or stroke. The formation of obstructive plaques in your arteries causes them to lose their flexibility and makes blood flow with greater force past the middle and inner ear. This powerful blood flow creates a perceptible sound in both ears. This sound of blood circulation is called pulsatile tinnitus. In addition to pulsatile tinnitus, other symptoms of atherosclerosis include: upper body pain, shortness of breath, irregular heartbeat, difficulty speaking and understanding speech, severe headaches, facial muscle drooping, and paralysis.
2. Overactive Thyroid or Hyperthyroidism
This is a non-vascular cause of pulsatile tinnitus. It is a condition that affects the thyroid gland, located at the front of the neck. It is characterized by weight loss, bulging eyes, an irregular menstrual cycle, and a goiter. The thyroid is responsible for producing triiodothyronine (T3) and tetraiodothyronine (T4). These two hormones regulate how your body's cells use energy. Their release helps regulate your metabolism. Hyperthyroidism occurs when your thyroid starts producing too much T4 or T3. Its most common cause is an autoimmune disease called Graves' disease. This disease triggers the production of antibodies that stimulate the thyroid and cause it to secrete these hormones in excess. Hyperthyroidism can also be caused by other factors, such as benign tumors of the pituitary gland or thyroid, thyroid inflammation, excess iodine, or tumors of the ovaries and testicles. High levels of T4 and T3 can skyrocket your basal metabolic rate and cause hand tremors, accelerated heart rate, and increased blood pressure. This increase in pressure causes blood to flow through your veins with more force, which can cause pulsatile tinnitus.
3. Irregular Blood Vessels
Most cases of pulsatile tinnitus can be attributed to the presence of irregular blood vessels in the body, particularly in the head. Blood vessels can be kinked or damaged by various factors. When the affected vessels are near the ear, the blood flow within them causes you to hear pulsatile tinnitus. The affected vessel can be a vein or an artery. The carotid artery and jugular vein are the two vessels in the head whose deformation can cause tinnitus. Damage to the vessel leads to a change in pressure within it and generates an audible sound. Health problems such as high blood pressure can alter blood flow in the vessels. Alcohol, caffeine, and stress can also amplify the sound and make it more noticeable.
4. Ear Abnormalities
Certain ear abnormalities, such as superior semicircular canal dehiscence syndrome, a condition affecting the superior semicircular canal of the inner ear, can cause pulsatile tinnitus. This syndrome occurs when the part of the temporal bone that covers the superior semicircular canal is absent or abnormally thin. Similarly, ear abnormalities leading to thinning or absence of the bone covering the main veins and arteries passing near the ear can cause you to hear your own heartbeat, hence pulsatile tinnitus.
5. Sinus Wall Abnormalities
Sinus wall abnormalities, such as sigmoid sinus diverticulum, can cause pulsatile tinnitus. The sigmoid sinus is a blood vessel located on the side of the brain, which receives blood from the cerebral veins. Sigmoid sinus diverticulum occurs when small pouches, called diverticula, begin to form. These pouches protrude through the wall of the sigmoid sinus and enter the mastoid bone behind the ear. Dehiscence, on the other hand, corresponds to the absence of part of the bone surrounding the sigmoid sinus in the mastoid. Both sigmoid sinus diverticulum and dehiscence alter blood flow, as well as the pressure and sound of this flow. Since this area is very close to the ear, the change in pressure results in pulsatile tinnitus.
6. Idiopathic Intracranial Hypertension
This is a medical condition that occurs when the pressure around the brain is too high. This high pressure causes symptoms such as headaches, tinnitus, blind spots, double vision, neck and shoulder pain, and temporary blindness. The brain and spinal cord are surrounded by a fluid called cerebrospinal fluid (CSF). When this fluid begins to accumulate in the skull, it puts additional pressure on the optic nerve and the brain. Idiopathic intracranial hypertension is so named because the exact cause of this pressure is unknown. This additional pressure on the brain and optic nerve causes the onset of pulsatile tinnitus, among other symptoms already mentioned. Idiopathic intracranial hypertension can be treated with certain medications, surgery, or weight loss. Once managed, pulsatile tinnitus disappears.
7. Head and Neck Tumors
The development of tumors in the head or neck can compress the blood vessels in this region and cause pulsatile tinnitus. Glomus tumors, for example, which are common in the jugular vein below the middle ear, can lead to tinnitus. Although benign, this type of tumor is locally invasive. These tumors are highly vascularized, and their proximity to the ear can cause pulsatile tinnitus due to the pressure they exert on the blood vessels of the head and neck.
8. Other Causes
In addition to the seven causes of pulsatile tinnitus we have just discussed, here are some additional factors that may cause tinnitus: Paget's disease, head trauma, conductive hearing loss, and high blood pressure.
Conclusion
Pulsatile tinnitus should never be ignored, as it always signals a health problem. As uncomfortable as it may be, it is most often temporary: once the underlying cause is treated, the sound fades. But remember that prompt medical attention is essential. Have you ever suffered from pulsatile tinnitus? What was the cause? Share your experience in the comments.
