Introduction
Imagine hearing a rhythmic thumping or whooshing sound in your ear, perfectly in sync with your heartbeat, but there's no external source of this sound. It's not a figment of your imagination but a medical condition known as pulsatile tinnitus. This particular form affects less than 10% of people with tinnitus, causing distress and impacting their quality of life [1].
Pulsatile tinnitus is often described as a phantom noise that only the sufferer can hear. It can be as mysterious as it is frustrating, leaving many to wonder about its causes, symptoms, and treatment options. This comprehensive article aims to demystify this condition, providing a beacon of knowledge in a sea of uncertainty.
Whether you're a patient seeking answers, a healthcare professional looking for information, or a caregiver trying to understand what your loved one is going through, this guide is for you. Keep reading to uncover the mysteries of pulsatile tinnitus.
What Is Pulsatile Tinnitus?
Pulsatile tinnitus is a form of tinnitus where individuals hear a rhythmic pulsing sound, often in time with their heartbeat. This can be experienced in one or both ears and is often described as a whooshing or thumping noise.
Unlike other types, medical professionals can often hear pulsatile tinnitus when they perform examinations, making it an objective rather than a subjective condition. The sounds you hear can vary in pitch from a low roar to a high squeal, and in some cases, they can be so loud that they interfere with your ability to concentrate or hear external sound.
Pulsatile tinnitus is a symptom of some underlying condition that causes a change in the blood flow near your ear, and it isn’t as rare as once thought. In fact, in a study of 2613 patients with fibromuscular dysplasia, a type of arterial disease, 972 (37.2%) reported experiencing pulsatile tinnitus [2].
Pulsatile Tinnitus Causes
The causes of pulsatile tinnitus can vary, often rooting from conditions that involve changes in blood flow. These can include:
High Blood Pressure
Conditions such as hypertension can increase blood pressure, causing the rhythmic noise associated with pulsatile tinnitus. This is because high blood pressure can cause turbulence in the blood flow, especially in the narrow vessels, leading to pulsating in the ears.
Turbulent Blood Flow
Sometimes, the inside of a blood vessel may become irregular, causing the blood flow to become turbulent and create a pulsing sound. This is often the result of atherosclerosis, where the blood vessels become constricted due to the build-up of fatty deposits.
Vascular Tumours
In rare cases, a small tumour in the head or neck can press on blood vessels, leading to pulsatile tinnitus. These growths, known as glomus tumours, are usually benign but can cause significant symptoms due to their location.
Ear Muscle Disorders
Certain disorders can cause the muscles in the middle ear to contract, creating a clicking sound characteristic of pulsatile tinnitus. Such problems are rare but can be identified through a thorough medical examination.
Internal Jugular Vein Stenosis
This is a condition where there's a narrowing in the internal jugular vein, causing a disruption in the blood flow. It can lead to pulsatile tinnitus, among other symptoms.
Idiopathic Intracranial Hypertension
Idiopathic intracranial hypertension is characterised by increased pressure inside the skull, and pulsatile tinnitus is experienced by most patients with this condition. Research indicates that two conditions, transverse sinus stenosis (narrowing of major veins in the brain) and sigmoid sinus diverticulum (a small pouch forming in a major vein of the brain), could potentially cause pulsatile tinnitus in patients [3].
Venous Sinus Stenosis
Venous sinus stenosis is a condition where there's a narrowing of the venous sinuses, which are channels that drain blood from the brain. This constriction can increase the turbulence of the blood flow and cause pulsatile tinnitus.
Pulsatile Tinnitus Symptoms and Diagnosis
Pulsatile tinnitus can sometimes be an indication of a serious and potentially life-threatening condition. For this reason, it is crucial to understand its symptoms and the process of diagnosis to ensure timely treatment.
A study conducted over a 10-year period analysed the files of 84 patients with pulsatile tinnitus. The study found that a vascular disorder was found in 42% of the patients, while in 14% of participants, nonvascular disorders such as glomus tumour or intracranial hypertension with a variety of causes explained the tinnitus [4].
Symptoms
The primary symptom of pulsatile tinnitus is the perception of a rhythmic noise, like a heartbeat, in the ears. This noise can be constant or intermittent and can vary in volume. It is often more noticeable at night or during quiet periods. Other signs may include:
- A feeling of fullness in the ear
- Hearing loss
- Dizziness
- Pain in the ear.
It is important to note that the symptoms can vary depending on the underlying cause of the pulsatile tinnitus. For example, if the condition is caused by high blood pressure or atherosclerosis, the individual might also experience symptoms related to these ailments, such as headaches or chest pain.
Diagnosis
Diagnosing pulsatile tinnitus begins with a detailed medical history and physical examination. The doctor will ask about the characteristics of the noise, accompanying symptoms, and any known risk factors.
The process usually involves listening to the blood vessels in the neck and the area around the ear to check for an unusual sound that can be heard both by the patient and the doctor, known as objective tinnitus.
If pulsatile tinnitus is suspected, further tests are usually required to identify the underlying cause. These tests may include:
- Imaging tests: These can include an MRI or CT scan to check for any structural issues or abnormalities in the brain, neck, or ears. Such tests can also help to identify any vascular issues that may be causing the tinnitus.
- Ultrasound: This can be used to evaluate blood flow in the arteries and veins of the neck.
- Angiography: This is a more invasive test that involves injecting a dye into the blood vessels to make them visible on an X-ray. This can help to identify any issues with blood flow.
Pulsatile Tinnitus Treatments
Pulsatile tinnitus, like many medical conditions, does not have a one-size-fits-all solution. The approach is often tailored to the underlying cause of the condition. Here are some common treatment options:
Medication
Medication is often the first line of treatment, especially when the pulsatile tinnitus is caused by an underlying condition that can be managed with drugs. For instance, if high blood pressure is identified as the cause, antihypertensive drugs may be prescribed to manage the condition and subsequently alleviate the tinnitus symptoms.
Surgical Procedures
In some cases, surgical intervention may be necessary, especially when the tinnitus is caused by structural abnormalities in the blood vessels. For example, in cases of venous sinus stenosis, a procedure known as venous sinus stenting has been shown to be an effective treatment. Similarly, surgical repair may be required for conditions like arteriovenous malformations or aneurysms.
Lifestyle Changes
Lifestyle modifications can also play a significant role in managing pulsatile tinnitus. This can include stress management techniques, as stress is known to exacerbate tinnitus. Regular exercise, a balanced diet, and adequate sleep can also contribute to overall health and wellbeing, potentially reducing the severity of symptoms.
Cognitive Behavioural Therapy (CBT)
CBT is a type of psychological therapy that can help individuals tune out tinnitus. It does not eliminate the noise, but it teaches you to push it into the background. A 2023 study found that CBT significantly improved the quality of life of tinnitus patients and reduced the severity of their symptoms [5].
Sound Therapy
Sound therapy involves the use of external noise to alter the perception of, or reaction to, tinnitus. This can include white noise devices, hearing aids, or specialised devices worn within the ear that produce a constant white noise. This therapy can provide short-term relief, particularly for those experiencing tinnitus symptoms in quiet environments. However, it's important to note that while it can help manage the perception of tinnitus, sound therapy does not alter its actual volume in the long term.
While these treatment options can be effective, it's important to remember that success varies among individuals. Therefore, it's crucial to have open, ongoing discussions with your healthcare provider to find the most effective treatment plan for you.
Discover how to tune out tinnitus with our free webinar
Oto: Your Companion in the Journey with Pulsatile Tinnitus
At Oto, we understand the disruption that tinnitus can cause in your life. That's why we've developed a digital program that helps you push the noise to the background, allowing you to focus on what truly matters. Our mission is to support you in reducing your awareness of tinnitus, so you can reclaim your life from this intrusive condition.
Our digital program is the result of a unique blend of medical expertise and personal experience with tinnitus, combining the power of CBT with the convenience of a mobile app. Our easy-to-use platform offers a wealth of expert-crafted content designed to soothe your mind and help you notice your tinnitus less. Whether you need assistance with sleep, focus, or learning, Oto is there to support you.
For a more personalised journey towards habituation, we offer a 1-1 program with video coaching sessions and a free consultation with a tinnitus specialist. This comprehensive approach provides you with the tools you need to reduce the intrusion of tinnitus in your life.
With Oto, it feels like you're talking directly to a therapist, and with instant access anytime, anywhere, the necessary support is always at your fingertips. Plus, you can learn from the best with regular webinars and Q&As with top tinnitus experts.
So, are you ready to start your journey towards habituating to tinnitus? Download the Oto app on your iOS or Android device today and take the first step towards pushing tinnitus to the background of your life.
Conclusion
Pulsatile tinnitus, though distressing, is a condition that can be managed with the right knowledge and support. Understanding its causes and symptoms is the first step towards reducing its impact on your life. Remember, you are not alone in this journey. There are many resources and treatments available to help you push tinnitus to the background of your life.
One such resource is the Oto app, a digital program designed to support you in your journey with tinnitus. Ready to start habituating to tinnitus? Download the Oto app today and take the first step towards noticing your tinnitus less.
References
1. Hofmann, E., Behr , R., Neumann-Haefelin, T., & Schwager, K. (2013, June 28). Pulsatile tinnitus: Imaging and differential diagnosis. Deutsches Arzteblatt international. https://pubmed.ncbi.nlm.nih.gov/23885280/
2. Dicks, A. B., Gornik, H. L., Gu, X., Bacharach, M., & Mahlay, N. F. (2021). Association of fibromuscular dysplasia and Pulsatile Tinnitus: A report ... https://www.ahajournals.org/doi/pdf/10.1161/JAHA.121.021962
3. Lansley, J. A., Tucker, W., Eriksen, M. R., & Riordan-Eva, P. (2017). Sigmoid Sinus Diverticulum, dehiscence, and venous sinus stenosis ... https://www.ajnr.org/content/ajnr/38/9/1783.full.pdf
4. Waldvogel, D., Mattle, H. P., Sturzenegger, M., & Schroth, G. (1998). Pulsatile Tinnitus: A Review of 84 Patients. https://boris.unibe.ch/117566/1/415_2009_Article_82450137415.pdf
5. Webster, K. E., Dor, A., Galbraith, K., Haj Kassem, L., & Harrington-Benton, N. (2023). Non-pharmacological interventions for prophylaxis of vestibular migraine (Review). https://research-information.bris.ac.uk/ws/portalfiles/portal/368283389/Webster_et_al_2023_Cochrane_Database_of_Systematic_Reviews_3_.pdf
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