Pulsatile Tinnitus – Hearing Heartbeat in Ear

Tinnitus is the sensation of sounds which comes from inside, rather than outside, i.e. in the absence of an external source. It is often referred as the “ringing in the ears,” but can be some other characteristic sound as well such as buzzing, humming, grinding, hissing, or whistling. In some condition, a more complex sound may be heard such as machinery or twittering of birds.

There are people who even hear sounds which are similar to music or singing. These sounds may not be present every time. But if it is noticeable it is a steady noise, having no frequent or regular changes in its frequency.

Pulsatile tinnitus is also a type of tinnitus. It is characterized by noises that beat along with your pulse. It is also known as rhythmic, vascular, or pulse-synchronous tinnitus. This type of tinnitus is experienced by 3% of the total tinnitus sufferers.

What is pulsatile tinnitus?

Pulsatile tinnitus is due to blood circulation in and around your ears.

Unlike other tinnitus types, pulsatile tinnitus has an external physical sound source pick up by your ears. The amplified sound of the blood circulation through the arteries is what the person hears in pulsatile tinnitus.

The ringing sound with other tinnitus types is due to the abnormal electrical signals picked up by the nerves. Those abnormal electrical signals which are moving from ears to the brain.

Pulsatile-Tinnitus (1)


Some of the main symptoms of pulsatile tinnitus is hearing sounds similar to hearing heartbeat in ear or pulse. You can even calculate your pulse with the help of sounds heard in your ears. But it may be noticed in one or both ear which can be loud and distracting, or even unbearable.


Some other symptoms may also be noticed such as heart palpitations or feelings of lightheadedness. These symptoms must be evaluated by a professional as soon as possible. Call 911, if any sudden chest pain or other signs of a heart attack is experienced.

Some other symptoms may be noticed if you have high pressure in the fluid around your brain, which is known as idiopathic intracranial hypertension:

If you notice such symptoms, you may need to lose weight, take medication, or even have surgery in some conditions.

Pulsatile tinnitus causes

Pulsatile tinnitus may have many possible causes, but all of them stem from blood circulation issues. Unlike regular tinnitus, a specific health problem can be pinpointed by the doctors. Some of the most common causes are as follows:

High Blood Pressure

The pressure of blood against the inner walls of arteries increases with the rise in blood pressure. It is easier for your ears to detect the more forceful blood flow in arteries in or around the ears. Stress, alcohol or caffeine can worsen the condition.


The buildup of cholesterol, fats, and waste materials causes Blockage in your arteries which leads to turbulent blood flow. Due to this cause, a person may be able to hear a rhythmic sound in one or both the ears.

Turbulent Blood Flow

A change in blood flow to and from the head may also be caused due to narrowed neck arteries (i.e. carotid arteries) or veins (i.e. jugular veins). This turbulent or irregular circulation may be picked up by your ears, leading to pulsatile tinnitus.

Head or Neck Tumors

Pulsatile tinnitus can also be caused due to a tumor that presses against a vein.

Abnormal Capillaries

Pulsatile tinnitus can also be caused due to a problem with the tiny blood vessels i.e. capillaries that help connect arteries to veins. This condition is generally known as arteriovenous malformation and affects only one ear. Therefore, the connection problem between arteries and veins.

Irregular Blood Vessels

With the flow of blood through damaged or kinked vessels in the brain and near or around the ear, there can be a change in pressure and noise. A narrow or kinked neck artery or vein can also be the reason for the sound.


If you think you’re experiencing pulsatile tinnitus then get an appointment with your otolaryngologist as soon as possible. A review of your symptoms and your medical history will be the first step of your examination.

With the help of a stethoscope, the doctor will try to listen to the chest, neck, and skull. You have objective pulsatile tinnitus if your doctor can also hear a pulsatile noise. If this is not the case then it is categorized as subjective pulsatile tinnitus.

A hearing test will also be conducted for determining whether there has been any hearing loss in one or both ears. Some imaging tests may also be ordered by your doctor, such as:

  • ultrasound
  • MRI
  • CT scan
  • angiography

Some other tests may also be conducted to test for high blood pressure and some blood test to check for thyroid disease or anemia. They can cause your blood to flow quickly and loudly. Jaws and eyes may be checked for the signs of increased pressure in your brain.


They will also about the medical history of a person. Such as if they have experienced any other symptoms of hearing loss or they are on medications that list tinnitus as a side effect.

You may be referred to a cardiologist for screenings for possible circulation problems or high blood pressure if it appears that you have pulsatile tinnitus.

Some more tests for diagnosis:

  • Brainstem Auditory Evoked Response (BAER): In this, electrical waves from your brain are timed in response to clicks in the ear.
  • Electrocochleography is similar to BAER but is done by placing an electrode on or in your eardrum.


Pulsatile tinnitus can be the reason behind sleeping problems which can lead to:

  • low energy
  • cardiovascular problems
  • difficulty with concentration
  • weight gain and other metabolism issues

Cure & Treatments: How to get rid of pulsatile tinnitus

The treatment options for Pulsatile tinnitus is often started by addressing the underlying cause. Once the underlying cause is treated, the sound should stop automatically.

The condition of high blood pressure can be treated with the combination of medications as well as lifestyle changes, which includes:

  • no smoking
  • regular exercise
  • stress reduction
  • a low-sodium diet

Surgery or a catheter procedure may be needed to treat the cause related to a specific problem in an artery or vein. Stent, a flexible mesh tube, is placed in a blocked artery to open it up and improve blood flow. Hence, reducing the blood pressure.

If you can listen to the tinnitus noise, but your doctor can’t find out a cause, then you may try:

Sound Therapy

If due to some reasons, the blood vessel can’t be treated, sound therapy will be beneficial in that condition. Sound Therapy involves the use of background noise, such as soft music or “white noise”. It will distract you from the tinnitus noise or brain’s sensitivity to the pitch of the tinnitus will be changed. Some other sounds may be used for the distraction such as environmental noise, music, table-top sound generators etc.

This method can help the noise to be less noticeable, especially at night. A special machine is there that makes it. Or figure out if an air conditioner or fan in your bedroom may help. There are some smartphone apps which are helpful in creating white noise.


While a person is in relax mode, certain changes take place in their body.  This includes a drop in the heart rate, blood pressure, and some other brain activities.

Certain Relaxation techniques are helpful in reducing the impact pulsatile tinnitus, such as breathing exercises, mindfulness, and meditation.

Cognitive Behavioral Therapy

Cognitive behavior therapy may be beneficial. It is a form of talk therapy which is designed to change your thoughts about a problem. Hence, changing your emotional reaction towards it and the way you behave towards it.

The aim of Cognitive behavioral therapy (CBT) is to change the way people react to their tinnitus rather than remove the noise. The motive is to learn techniques for improving the way a person thinks and acts towards their tinnitus.

Tinnitus Retraining Therapy

The aim of Tinnitus retraining therapy (TRT) is to help people manage the impact of tinnitus on their everyday life. Directive counseling and sound therapy are used in TRT. In this, the sufferer wears a device that will play music at such a frequency that helps to tune out the tinnitus.

Wearable Sound Generators

Wearable sound generators are the masking devices which are helpful in creating a constant, low-level background noise. Its appearance is similar to hearing aids.

There are some more treatment options such as Counselling, Mindfulness meditation. These can be helpful in managing the tinnitus if no identifiable cause can be found.


The outlook for pulsatile tinnitus is totally dependent on its underlying causes. Most of the conditions responsible for pulsatile tinnitus can be treated with the help of medications and certain lifestyle changes.

In pulsatile tinnitus, most of the underlying causes are treatable, but proper diagnosis is still required.

If pulsatile tinnitus is left untreated, it can negatively impact a person’s quality of life. But there are many other self-management approaches as well, which can be helpful in reducing the symptoms.

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