Pulsatile Tinnitus FAQ

What is tinnitus?

Tinnitus is a ringing, buzzing, hissing, whistling or clicking in one or both ears. It occurs in the absence of external sound. This sound may or may not be present at all times. When it occurs, it is steady, without changes in loudness or pitch. Tinnitus interferes with everyday life for 20 million people in the U.S. For 2 million of them, it can be debilitating. Learn more about tinnitus.

What is pulsatile tinnitus?

Pulsatile tinnitus (pulse synchronous) is a rhythmic pulsing noise in one or both ears. It occurs in the absence of external sound. It tends to be synced with the heartbeat. The noise is often described as a “whooshing,” sound heard when the heart beats. Pulsatile tinnitus symptoms can increase or decrease when you lie down or turn your head. Symptoms can also change when you put pressure on the jugular vein.

What causes pulsatile tinnitus?

Pulsatile tinnitus has many causes. It often occurs due to issues in the blood vessels, or the vascular system, in the head and neck.

Vascular causes include:

  • Venous hum. This benign condition occurs when blood flow is abnormal in the jugular veins. This causes a vibration you can hear.
  • Idiopathic intracranial hypertension (increased pressure in the skull). This condition is marked by headaches, vision issues and pulsatile tinnitus. The two large veins that bring blood out of the brain (transverse sinuses) are narrowed. This narrowing causes the “whooshing” tinnitus. It is like how a whistle works (it pushes air through a narrowed space). In most cases, this condition is treated with medication. In severe cases, it may be treated with minimally invasive methods to relieve the narrowing of the veins.
  • Sigmoid or jugular sinus diverticulum. This is a rare condition. It occurs when the veins at the base of the skull protrude and extend close to the inner ear structures. This condition is not dangerous. It is treatable with endovascular (minimally invasive) techniques.
  • Dural arteriovenous shunts. These abnormal connections develop between arteries and veins in the lining around the brain. This abnormal connection forms in the walls of the large veins that return blood from the brain to the heart. The noise occurs due to the flow of high-pressure blood from the arteries to the veins at the base of the skull. These lesions can be low-grade (no danger of stroke) or high-grade. Low-grade lesions may be treated if symptoms affect your quality of life. High-grade lesions must be treated. If left untreated, there is a high risk of brain injury. In most cases, treatment for both types is minimally invasive.
  • Arterial stenosis. This is narrowing of the blood vessels (arteries) in the neck that carry blood to the brain. It can be a risk factor for stroke.

Other factors may increase your awareness of the sound of blood pumping through your blood vessels. These can include:

  • Conductive hearing loss. This can be caused by a ruptured ear drum. You may be more aware of internal sounds because you cannot hear external ones.
  • Neurological issues. You may hear sounds more intensely than normal.

How is pulsatile tinnitus diagnosed?

First, your multidisciplinary care team will ask about your medical history. Then they will thoroughly check the blood vessels in your head, neck and ear canal. You may also have hearing and blood tests.

You will also likely have imaging tests. They will show what is happening inside your skull. These may include:

  • Ultrasound checks the arteries in the neck. This test can exclude a narrowing.
  • MRI shows details of the brain and the inner ear.
  • Magnetic resonance angiography (MRA), magnetic resonance venography (MRV), computerized tomographic angiography (CTA) and computerized tomographic venography (CTV) can check the arteries and veins inside the head. These tests can detect abnormal narrowing or short circuit connections.
  • CT scan to check the brain and skull base.
  • Conventional angiography is a minimally invasive, high-resolution evaluation of the arteries and veins. This is done to check or rule out high-grade dural arteriovenous shunts. It is also used to plan treatment. If your healthcare provider suspects high pressures in the head, they may use this technique to measure direct pressure of the veins.

How is pulsatile tinnitus treated?

Pulsatile tinnitus can often be cured once your healthcare provider finds and treats the underlying cause. Your treatment will depend on the cause of your condition. Treatment options may involve:

  • Medication is used to treat some underlying conditions. These include hyperthyroidism, anemia, elevated intracranial hypertension or high blood pressure.
  • Endovascular minimally invasive surgery, such as stenting, can correct certain underlying conditions, including an aneurysm.
  • Self-management techniques may help ease your symptoms if you do not have an underlying cause. These may include sound therapy, cognitive behavioral therapy and tinnitus retraining therapy.