Tinnitus is the sensation of hearing sounds from inside, rather than outside, the body. One characteristic sound is a "ringing in the ears," which can describe buzzing, humming, grinding, hissing, or whistling.
Some people hear sounds similar to music or singing.
Pulsatile tinnitus is a rhythmical noise that beats at the same rate as the heart and is the sound of blood circulating the body. A person can confirm this by feeling their pulse as they listen to the tinnitus noise.
Unlike other forms of tinnitus, which are thought to be caused by a disconnect between the sounds the ears hear and the way the brain interprets them, pulsatile tinnitus has a physical source.
Pulsatile tinnitus occurs when the ear becomes aware of a change in blood flow in nearby blood vessels. These include the arteries and veins in the neck, base of the skull, and in the ear itself.
The main causes are:
Generalised increased blood flow
When blood is flowing quickly, such as during strenuous exercise or pregnancy, it makes more noise.
Severe anemia or an overactive thyroid gland may also cause general increased blood flow in the body.
Localised increased flow
Sometimes, blood flow increases in just one or one group of vessels. Tumors in the head and neck can lead to the development of abnormal blood vessels, which can result in pulsatile tinnitus.
The majority of tumors associated with pulsatile tinnitus are benign, meaning they are not cancerous.
Turbulent blood flow
Atherosclerosis, or hardening of the arteries, makes the insides of the blood vessels lumpy. This leads to a turbulent and louder blood flow.
If someone is suffering from a condition causing conductive hearing loss, such as a perforated eardrum or secretory otitis media (glue ear), they tend to be more aware of sounds from inside their body.
People can also experience a heightened sensitivity in their auditory pathways, meaning the brain is alerted to normal noises in the blood vessels that it would usually ignore.
It is unclear what causes the condition, but young and middle-aged women who are overweight are most at risk.
To diagnose tinnitus, a doctor will ask questions such as whether the sound is continuous, if it affects one or both ears, and what kind of impact it is having on a person's everyday life.
They will also ask whether a person has experienced any other symptoms of hearing loss or has been taking medications that list tinnitus as a side effect.
They will examine the inside and outside of the ear to check for problems that might be easy to treat, such as an infection or excess earwax.
A specialist will examine the eyes, head, and neck, and do a hearing test.
If a specific cause is found for pulsatile tinnitus, doctors can treat the underlying condition.
Anemia can be treated with medication or blood transfusions. Secretory otitis media may be treated with a tympanostomy tube, or grommet. Perforated eardrums can be closed with grafts, and narrowed segments of an artery can be repaired.
If caused by a specific blood vessel, doctors may or may not be able to repair it, depending on where the vessel is located.
If there are no medical interventions, a person can try several self-management techniques, including:
Sound therapy, also called sound enrichment, was originally developed as a form of distraction. Many people with tinnitus notice their symptoms more when in a quiet environment, so listening to other sounds can make them less intrusive.
Sound therapy is the deliberate use of any sound to reduce a person's awareness of tinnitus. A person could try listening to:
- environmental noise, such as from an open window
- music or the radio
- a dedicated smartphone App
- table-top sound generators
- a wearable sound generator
Certain changes take place in the body when a person relaxes, including a drop in their heart rate, blood pressure, and some brain activity.
Relaxation techniques, such as breathing exercises, mindfulness, and meditation, may also reduce the impact pulsatile tinnitus can have on everyday life.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) aims to change the way people react to their tinnitus rather than remove the actual sounds. The idea is to learn techniques to improve the way a person thinks about and acts towards the tinnitus.
Tinnitus retraining therapy
Tinnitus retraining therapy (TRT) is a form of therapy that aims to help people manage the impact tinnitus has on their everyday life. TRT uses directive counseling and sound therapy.
Many of the underlying causes of pulsatile tinnitus are treatable, but it is important to see a doctor for a proper diagnosis.
Untreated pulsatile tinnitus can have a negative impact on a person's quality of life, but there are many different self-management approaches that can help reduce symptoms.