Have you ever heard a sound inside your head, or inside your ears, that sounds like "duk duk" or "shoo... shoo..." to the beat of your heart? This can be a strange experience that only you can hear, and that no one else can hear. Sometimes this sound is very quiet, and other times it is very loud. If you have experienced something like this, it is very important to be aware of the condition we are going to talk about today, called Pulsatile Tinnitus .
What is Pulsatile Tinnitus?
Simply put, Pulsatile Tinnitus is a rare form of tinnitus. Typically, someone with tinnitus hears a constant, ringing sound inside their head, often resembling a "ringing..." sound. However, in Pulsatile Tinnitus, the sound you hear is a rhythmic change in response to your heartbeat. That is, the sound is heard in time with your heart.
The important thing is that Pulsatile Tinnitus is not a single disease . It is a symptom of another medical condition. Most of the time, it is caused by a problem with our vascular system, or veins and arteries, by abnormalities in blood flow to the ear, and in rare cases, by tumors.
How does this affect your body?
Like regular tinnitus, pulsatile tinnitus can interfere with your daily activities . It can cause sleeplessness, difficulty concentrating, and inability to complete tasks. For some people, it can even lead to depression , anxiety , or other mental health issues.
But, most importantly, Pulsatile Tinnitus can be the first warning sign of a serious underlying condition in your body. Therefore, it is not something to simply ignore.
When should we think seriously about this?
It is wise to seek medical advice immediately if you experience any sudden, unexplained changes in your body. Especially,
- If you suddenly start hearing a rhythmic "shoo... shoo..." sound inside your head.
- If only one ear could hear that sound.
- However, if you have difficulty walking, feel unsteady, or experience some vision impairment.
If you have these symptoms, you should see a doctor immediately .
Is this a common situation?
No, Pulsatile Tinnitus is a very rare condition . Of the approximately 50 million people who have tinnitus, only about 10% have Pulsatile Tinnitus.
What are the symptoms of Pulsatile Tinnitus?
The main and most common symptom is a "shoo... shoo..." sound that you hear inside your head in a rhythmic pattern that matches your heartbeat . It feels like blood is rushing past your ear. This is caused by blood moving faster than normal through the blood vessels around your ear, either the large arteries or veins in your neck and base of your skull, or the small arteries inside your ear. Simply put, someone with Pulsatile Tinnitus hears what sounds like their own heart beating .
What causes this?
Pulsatile Tinnitus is generally caused by a change or abnormality in the blood flow in or around your ears. Sometimes, this change in blood flow can be a sign of a serious underlying medical condition . However, not everyone who has Pulsatile Tinnitus has this serious condition.
In some cases, this may not be due to changes in blood flow, but rather to an increased ability to hear the sound of blood flowing .
Here are some possible causes of Pulsatile Tinnitus:
- Atherosclerosis: This is the thickening and hardening of your artery walls. Just as a quiet river becomes a roaring waterfall when it passes through rocks, when blood flows unevenly like this, the arteries near your ears can produce more noise.
- Sinus wall abnormalities (SWAA): The sinus wall on the side of your brain is a channel that receives blood from the veins inside your brain. In some people, conditions that increase blood flow through this channel can cause a noise, which is what causes the "swoosh..." sound heard in Pulsatile Tinnitus.
- Arteriovenous malformations: These are tangled blood vessels that affect the connections between your veins and arteries. If you have this type of malformation near your ears, you may experience pulsatile tinnitus.
- Hypertension: High blood pressure is the pressure exerted by blood on the walls of your blood vessels. If this pressure is too high, it can also cause pulsatile tinnitus.
- Anemia: Anemia can increase your blood circulation, which can also affect the blood vessels and cause pulsatile tinnitus.
- Middle ear tumors: Some people can develop small tumors in the middle ear, near the parts that receive sound. These are called glomus tumors , and they have many blood vessels. Sometimes, the sound of blood flowing through the blood vessels in these glomus tumors can also cause pulsatile tinnitus.
- Idiopathic intracranial hypertension: This is when cerebrospinal fluid builds up around your brain, putting pressure on blood vessels and affecting blood flow.
- Head trauma: About 53% of people who have suffered a head injury experience tinnitus, including pulsatile tinnitus.
- Hyperthyroidism: This condition can cause your heart to beat faster, which increases blood flow.
- Paget's disease: Paget's disease is a chronic disease that affects the bones, and in some people it can also affect the skull. About 20% of people with Paget's disease experience hearing loss, including pulsatile tinnitus.
How do doctors diagnose this?
Doctors will first listen to your heart beat using a stethoscope and then your neck and skull. (If the doctor can hear a sound that matches your heartbeat, it's called objective pulsatile tinnitus . If they can't, it's called subjective pulsatile tinnitus .)
However, doctors will check to see if your Pulsatile Tinnitus is happening in sync with your heartbeat. They will also check your hearing . During this hearing test, they may also do a special test called tympanometry to measure the pulse in your ears and see if it matches your heartbeat.
Depending on your other symptoms, your doctor may order various imaging tests . These tests allow doctors to "see" what's going on inside your head and neck to see if there's anything that might be causing your Pulsatile Tinnitus. These tests may include:
- Angiography: This test uses a contrast material and X-rays to examine your blood vessels.
- Magnetic resonance angiography (MRA): This test is done to check for problems with the blood vessels in your head and neck.
- Magnetic resonance imaging (MRI): An MRI uses a magnetic field and radio waves to make cross-sectional images of specific structures or tissues in your body. It can be used to make images of tissues in the ears and neck.
- Doppler ultrasound: This test is used to see how blood flows through the blood vessels in your neck.
- Computed tomography (CT) scan: This uses X-rays and a computer to create a three-dimensional (3D) image of your head and neck.
- High-resolution computed tomography (HRCT) scan: This uses a narrow beam of X-rays and advanced computer analysis to create very detailed images of your blood vessels or other parts of your head and neck. HRCT scans can be used to look for things like sinus wall abnormalities (SWAA) .
How is this treated?
Doctors treat pulsatile tinnitus by identifying and treating the underlying cause . For example, if you have pulsatile tinnitus due to atherosclerosis , your doctor may prescribe medication to control the condition. These medications can help reduce or eliminate the ringing in your ears.
Sometimes, tests may not find any underlying medical condition. However, your doctor can help you manage your Pulsatile Tinnitus. Here are some ways to do so:
- Sound generators: These devices play sounds into your ears to help reduce tinnitus and pulsatile tinnitus. For example, they can play soothing sounds like falling water or gentle rain. Some people may also benefit from hearing aids with sound generators.
- Environmental enrichment devices: You can create your own ways to reduce the noise of tinnitus. Devices that emit soothing background noises on a table, music recordings, nature sounds, or apps on smartphones and tablets can help reduce the noise of tinnitus.
- Relaxation techniques: This constant heartbeat can make you feel stressed and frustrated. Learning ways to calm your mind and reduce stress can help you deal with that stress and frustration.
- Counseling options: Some people benefit from mental health therapies such as Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT) . These therapies can help you learn to pay less attention to the noises in your head.
Can this be prevented?
Pulsatile Tinnitus is caused by a change in your blood flow. Therefore, you may not always be able to prevent the underlying cause of Pulsatile Tinnitus.
What happens if I have Pulsatile Tinnitus?
Pulsatile tinnitus can be a symptom of a variety of underlying medical conditions. If your doctor is treating a specific condition, you can ask him/her if that treatment will eliminate or reduce the pulsatile tinnitus.
How do I take care of myself?
The best self-care you can do when you have Pulsatile Tinnitus is to talk to your doctor. If he/she can find the underlying cause and treat it, you may be able to get rid of the noise from Pulsatile Tinnitus.
Important: Pulsatile Tinnitus is rare. Like regular Tinnitus, it can affect your quality of life. You may not be able to sleep when you want to rest, and you may not be able to concentrate when you want to. The difference is that regular Tinnitus is just a buzzing sound, while Pulsatile Tinnitus is like a live soundtrack of blood pumping in and out of your heart.
Final Take-Home Message
As annoying as it may be, this "soundtrack" could be life-saving. Pulsatile tinnitus can be the first warning sign of a serious condition affecting your blood circulation. So, if you hear a ringing sound in your ears that changes rhythmically with your heartbeat, see a doctor immediately . Then, if there is an underlying, possibly serious problem, you can find out and take steps to treat it. Remember, early detection is the best way to prevent many diseases!
` Pulsatile tinnitus, ringing in the ears, heartbeat, vascular disease, tinnitus, ear disease, health
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