Pulsatile Tinnitus

Understanding Pulsatile Tinnitus

Pulsatile tinnitus is a relatively uncommon variation of tinnitus, a condition where individuals perceive constant sounds within their ears that are inaudible to others. While tinnitus is often described as a ringing noise, it can take various forms. Pulsatile tinnitus, as the name suggests, is characterized by noise that appears to sync with the person’s heartbeat, resembling a rhythmic whooshing sound. It’s essential to understand that pulsatile tinnitus itself is not a standalone medical condition; instead, it serves as a symptom of underlying disorders.

Typically, pulsatile tinnitus is associated with vascular diseases that affect veins and arteries, as well as abnormalities in vascular structures or irregular blood flow near the ear. In rare instances, it may also be linked to the presence of tumors. Therefore, it is crucial for individuals experiencing pulsatile tinnitus to seek medical evaluation and diagnosis to identify the underlying cause and receive appropriate treatment.

Symptoms

Pulsatile tinnitus typically manifests as a rhythmic whooshing or swooshing sound inside the head, often synchronized with the individual’s heartbeat. This phenomenon commonly occurs when blood flows at an accelerated rate through various veins and arteries in proximity to the ears. These vascular pathways may encompass major arteries or veins in the neck and at the base of the skull, as well as smaller arteries within the ears. Essentially, those experiencing pulsatile tinnitus perceive the rhythmic beating of their own hearts.

Several factors and conditions can lead to pulsatile tinnitus by altering the blood flow in the vessels surrounding or near the ears. However, it’s important to note that the presence of pulsatile tinnitus doesn’t necessarily indicate the presence of these underlying conditions. In some instances, pulsatile tinnitus results from an increased sensitivity to the sounds of blood flow rather than an actual change in blood circulation.
Here are some examples of conditions that may contribute to the development of pulsatile tinnitus:

Atherosclerosis:

This condition involves the hardening of arteries, resulting in uneven blood flow. Much like a tranquil river transforming into turbulent rapids, uneven blood flow generates more audible noise compared to smooth blood circulation in the arteries near the ear.

Sinus Wall Abnormalities (SWAA):

The sinus wall acts as a channel on the side of the brain, receiving blood from intracranial veins. Some individuals may have conditions that lead to heightened blood flow within this channel, causing audible whooshing sounds associated with pulsatile tinnitus.

Arteriovenous Malformations:

These are clusters of blood vessels affecting the connections between veins and arteries. Pulsatile tinnitus can develop when arteriovenous malformations occur near the ears.

High Blood Pressure (Hypertension):

Elevated blood pressure levels result in increased force against the walls of blood vessels. Excessive pressure may lead to pulsatile tinnitus.

Anemia:

Anemia can elevate blood flow, potentially affecting blood vessels and causing pulsatile tinnitus.

Middle Ear Tumors:

Glomus tumors, characterized by numerous blood vessels, can develop in proximity to the parts of the ear responsible for sound reception. In some cases, people experience pulsatile tinnitus as they hear blood flowing through the blood vessels within these tumors.

Idiopathic Intracranial Hypertension:

This condition arises when cerebrospinal fluid accumulates around the brain, exerting pressure on blood vessels and potentially influencing blood flow.

Head Trauma:

Approximately 53% of individuals who sustain traumatic head injuries may develop tinnitus, including the pulsatile variant.

Hyperthyroidism:

An overactive thyroid gland can accelerate heart rate, leading to increased blood flow, which, in turn, may cause pulsatile tinnitus.

Paget’s Disease:

This chronic bone disorder can affect the skull, with around 20% of affected individuals developing hearing issues, including pulsatile tinnitus.

It’s essential for individuals experiencing pulsatile tinnitus to seek medical evaluation to determine its underlying cause and explore appropriate management options.

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Diagnosis

Healthcare providers often initiate the diagnostic process for pulsatile tinnitus by employing a stethoscope, a familiar instrument used to listen to the heartbeat when placed on the chest. In this case, providers use it to listen to the neck and skull. If they detect audible sounds synchronized with the pulse, they classify it as objective pulsatile tinnitus. Conversely, if they do not perceive such sounds, it falls under the category of subjective pulsatile tinnitus.

Irrespective of the type of pulsatile tinnitus, healthcare providers aim to determine if the pulsations align with the individual’s heartbeat and conduct hearing tests. During these assessments, they may utilize a specialized examination known as tympanometry to gauge the pulsation within the ears and assess its correlation with the pulse.

Depending on the accompanying symptoms, healthcare providers may request various imaging studies to visualize the internal structures of the head and neck, pinpointing potential causes of pulsatile tinnitus. These imaging tests may include:

Angiography:

This diagnostic examination employs contrast material and X-rays to facilitate the thorough examination of blood vessels.

Magnetic Resonance Angiography (MRA):

MRA focuses on identifying issues within the blood vessels of the head and neck.

Magnetic Resonance Imaging (MRI):

Utilizing a magnetic field and radio waves, an MRI generates cross-sectional images of specific structures or tissues within the body. It may be employed to visualize the tissues in the ears and neck.

Doppler Ultrasound:

This test assists in assessing blood flow through the neck’s blood vessels.

Computed Tomography (CT) Scan:

By utilizing X-rays and computer processing, a CT scan produces three-dimensional images of the head and neck.

High-Resolution Computed Tomography (HRCT) Scan:

HRCT employs a focused X-ray beam and advanced computer analysis to create exceptionally detailed images of blood vessels or other components of the head and neck. HRCT scans are often utilized to identify sinus wall abnormalities (SWAA).
These diagnostic procedures allow healthcare providers to gain insights into the potential sources of pulsatile tinnitus, facilitating accurate diagnosis and subsequent management.

Treatment

Healthcare providers approach the treatment of pulsatile tinnitus by first identifying and addressing the underlying medical condition responsible for the symptoms. For instance, if pulsatile tinnitus is attributed to atherosclerosis, your healthcare provider may prescribe medications to manage this condition. These medications can effectively reduce or eliminate the rhythmic swooshing sound caused by your heart pulsations within your ear.