Pulsatile Tinnitus: Hearing Heartbeat, Fluttering, Whooshing Sound in Ear

Ranjeet KumarReviewed by Mr. Ranjeet Kumar Sr. Audiologist, Speech Therapist & Cochlear Implant Specialist, BASLP on Sep 23rd, 2019 written by Editorial Team

If you often experience fluttering, whooshing or thumping sound in one or both ears and it follows a steady rate. Then, there is a probability that you are experiencing pulsatile tinnitus.

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What is Pulsatile Tinnitus?

You may know about tinnitus, but do you now about pulsatile tinnitus? Let’s learn more about pulsating in the ear.

The word pulsatile means rhythmic pulsation. Pulsatile tinnitus is a rhythmical noise that beats along with your heart. It is also known as rhythmic, vascular, or pulse-synchronous tinnitus.

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This type of tinnitus is experienced by 3% of the total tinnitus sufferers. Distinguishing and identifying this rare and less common forms of tinnitus is necessary as the concealed cause of pulsatile tinnitus or muscular tinnitus can be identified by the doctors and treated.

If you suspect any type of hearing loss, the very first step is to consult hearing care professional right away. Give us a call on our toll-free 1800-121-4408.

Unlike other tinnitus types, the whooshing and thumping in-ear sound and 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 sound.

It becomes necessary to know all the symptoms of hearing a heartbeat or fluttering in the ear. In some cases, there is a chance of some hidden condition that could cause a serious problem. Also, in rare conditions, there is a chance of terrible events including strokes.

Pulsatile Tinnitus in One Ear

The pulsing sound in the ears, pain or ache, heart-pulsing like swirling, throbbing, beating sound, or apparently behind the ear. Its occurrence can be in one or both ears and can randomly shift from ear to ear or from one ear to both ears.

You might feel this symptom like your heart is beating in your ear. And sometimes it is diagnosed as pulsing in the ear.

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Symptoms of Pulsatile Tinnitus

One of the main symptoms of pulsatile tinnitus is hearing a pulse-like sound in your ear which is similar to hearing your heartbeat. 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.

pulsatile-tinnitus

You may experience other symptoms of tinnitus such as heart palpitations or feelings of lightheadedness. These symptoms must be evaluated by a professional as soon as possible.

In case you experience high pressure in the fluid around your brain, which is known as idiopathic intracranial hypertension. Then you may find some symptoms such as:

  • Headaches
  • Dizziness
  • Whooshing or fluttering or thumping sound in the ear
  • Vision problems
  • Hearing heartbeat in ear
  • Hearing loss

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

During the investigation of tinnitus cases, it can be difficult to detect one single known cause. Although in pulsing tinnitus, the chances of finding a specific cause are more as compare to the non-pulsatile tinnitus.

Symptom Checker Statistics for Pulsatile Tinnitus

With the help of the following statistics, you can check the symptoms.

Those people who have experienced heartbeat or thumping in the ear also have experienced-

  • 7% Headache
  • 4% Fatigue
  • 3% Dizziness

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Studies say that the people who have experienced thumping in the ear, have most often matched with the following disorders-

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Causes of Pulsatile Tinnitus

Pulsatile tinnitus may have many possible causes, unlike regular tinnitus in which a specific health problem can be pinpointed by the doctors.

Blood flow in pulsatile tinnitus

All of the possible causes are rooted in blood circulation issues. Due to the change in the flow of blood inside the vessels near the ear, pulsing in-ear occurs.

These vessels are present in the large arteries and veins inside the base and neck of the skull and in the ear.

This occurs due to blood circulation in and around your ears. If you quietly sit or lie down on your bed, you may feel your pulse in one or both ears. Tinnitus is often characterized by ringing in the ear.

But this variation of the pulse which you feel or experience in your ears is termed as pulsatile tinnitus. The sound you experience is caused due to the turbulent flow in the blood vessels in and head and neck.

In this way, this vascular tinnitus is different from the continuous tinnitus which results from damage to the hearing nerve or the cochlea.

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Although, any person may experience both continuous and pulsatile tinnitus together. Usually individual found this muscular tinnitus more troublesome as it has a physical source.

Also, the fluttering sound is usually not a cause for concern unless it occurs frequently, which could be a sign of high blood pressure, a blockage in the ear canal, or artery problems near the ear.

Following are some reasons for the problem in blood circulation which can cause Pulsatile Tinnitus:

1. Generalized Increased Blood Flow

Blood flowing at a high rate produce more noise in comparison to the blood flowing at a normal rate. This increased blood flow can occur due to heavy exercises, severe anemia, pregnancy, hyperthyroidism (an overactive thyroid gland). There are also other causes of increased ringing in ears blood pressure.

There is a common condition of high pressure of the cerebrospinal fluid that bathes the brain known as Benign Intracranial Hypertension (BIH). Most of the victim of this condition are overweight females. You can reduce the effect of this cause by engaging in weight loss programs or administration of a diuretic.

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There is also another condition in which increased blood flow may develop through the jugular vein known as Venous Hum. This jugular vein crosses the middle ear and the turbulent blood flow in the vein causes a “hum” in the middle ear.

2. Localized Increased Blood Flow

There may be cases of increased blood flow in a group or single blood vessels. In one such case, during the fetal development stapedial artery which is present inside our middle ear usually closes before we take birth. But in these cases of localized increased blood flow, it can occasionally persist causing the flow of blood near the middle ear and produce pulsing tinnitus.

Causes of localized increased flow –

  • Atherosclerosis – 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.
  • Tumors – These tumors may block, damage or compress blood vessels in the ear or in the surrounding area which results in an increase in the level of blood flow. These tumors linked with pulsatile tinnitus are found to be benign instead of malignant.
  • Head or Neck Tumors – Tumors of the neck and the head cause the development of abnormal blood vessels which later causes pulsatile sound. Pulsatile tinnitus can also be caused due to a tumor that presses against a vein.
  • Arteriovenous malformations – Deformed veins and arteries from birth can also be the reason of cause for tinnitus.

3. 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.

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4. 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 pulsing tinnitus.

5. Abnormal Capillaries

Thumping sound 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.

6. 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 which makes you hear a heartbeat in the ear.

7. Glomus Tumor

This tumor is present inside the ear or found below the ear at the skull base. Glomus jugular tumors begin their growth under the middle ear and then grow towards the bottom of the middle ear. Its symptoms include conductive or mixed hearing loss, pulsatile tinnitus, bleeding or ear pain in the ear.

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8. Atherosclerotic Carotid Artery Disease

It is a degenerative and diffusive disease of the arteries which results in plaques that contain lipids, necrotic cells, and cholesterol crystals. The build-up of cholesterol on the artery wall causes the narrowing of the artery which reduces the opening and results in turbulent flow and causes pulsatile tinnitus. Most of the victim of this disease are people having elevated cholesterol,  hypertension, angina, smoking, and diabetes. But with medication, this condition can be controlled.

9. Middle Ear Effusion

Due to inflammation, infection or Eustachian tube dysfunction fluids get to build up in the middle ear then it causes pulsatile tinnitus.

Middle ear infusion

It can also result in a feeling of fullness, hearing difficulty or ear pain.

For its treatment doctors suggest decongestants, nasal sprays, surgery, and antibiotics.

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10. Hypertension

There are some of the cases where pulsatile tinnitus is caused by taking high blood pressure medication. The problem can be resolved after changing the medication.

11. Twisted Arteries

Twisted arteries in the head and neck may result in turbulent blood flow which causes fluttering in the ear. Usually, it didn’t require any kind of treatment for its cure.

12. Other Causes

  • Arnold-Chiari malformation – In this malfunction both the brain stem cerebellum and extend into the foramen magnum. The cerebrum elongated and pushed down through the base of the skull opening which results in blocking the cerebrospinal fluid flow.
  • Hyperthyroidism – In hyperthyroid, the thyroid gland increases the production of hormones which results in pulsatile tinnitus.
  • Iron deficiency – Iron deficiency makes the blood thins and it flows through the bloodstream which causes pulsatile tinnitus.
  • Muscle spasm – Muscle spasm in the soft palate can result in “clicking sound”. These clicking sounds are brisk, intermittent and repetitive and are around at a speed of 60 – 200 beats per minute. This is linked with small vessel disease, degenerative neurological disorders or tumor, and multiple sclerosis. The muscles linked to the stapes bone inside the middle ear can spasm which result in the production of rumbling or cracking noises.

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How to Stop Pulsing in the Ear

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.

Read also: Is It Worrisome To Hear A Pulse In My Ear? What Do You Need To Know?

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 sound.

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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.

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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.

Diagnostic algorithm for pulsatile tinnitus. IJV = internal jugular vein, CTA/V = combined CT angiography and venography.

Diagnostic algorithm for pulsatile tinnitus
source: researchgate.net

Cure & Treatments: How to Get Rid of Pulsatile Tinnitus

The treatment options for fluttering 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:

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  • 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 blood pressure.

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

1. 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.

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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.

2. Relaxation

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.

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3. 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.

Certain Relaxation techniques are helpful in reducing the impact of fluttering sound, such as breathing exercises, mindfulness, and meditation.

4. 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.

5. Wearable Sound Generators

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

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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.


Outlook

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

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

If it 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.

That’s all in this article. If you need any help or have any query. Give us a call at 1800-121-4408 today, book an appointment for a FREE consultation at HearingSol Clinic Delhi NCR.
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