Pulsatile Tinnitus: When Your Right Ear Hears 'Thumping' Sounds

When someone speaks on the left side, there is often a "thumping" sound in the right ear?

This issue has been present for over a year, and it doesn't occur every time.
Initially, I thought it was due to stress from starting a new job.
After consulting with doctors and monitoring the frequency of occurrences, I noticed that the "thumping" sound only happens when someone speaks to me from my left side.
I have seen several otolaryngologists who all said there was no problem, no earwax, and after undergoing a hearing test (in a quiet soundproof room with headphones, I responded to sounds regardless of volume), they also confirmed there were no issues.
I have also observed whether it might be related to nasal allergies, but I rarely have allergies, and this condition occurs regardless of whether I have allergies or not.
I noted that the "thump" sound occurs at a frequency slightly faster than my heartbeat.
I usually don't wear headphones to listen to music, but recently I tried listening to speeches with headphones.
If I use headphones that produce sound in both ears, there is no "thumping" sound in my right ear.
However, when using headphones with separate left and right channels, if there is sound only in the left ear, the right ear experiences the "thumping" sound.
If I switch the left ear headphone to my right ear, this situation does not occur.
The "thumping" sound does not persist continuously; it does not happen every time, occurs occasionally, and lasts no longer than ten seconds, but the frequency varies.
Previously, a doctor suggested it might be due to "aging," stating that as long as it doesn't affect my hearing, I should coexist with it.
Could this condition potentially be indicative of another issue? Thank you!

Meigui, 40~49 year old female. Ask Date: 2017/05/31

Dr. Li Jiaxuan reply Otolaryngology

It is recommended to undergo a magnetic resonance imaging (MRI) scan of the inner ear and posterior fossa vessels at a medical center.
The likelihood of other causes of pulsatile tinnitus, such as vascular anomalies or small tumors, is low; however, precise examinations are indeed necessary to identify them.
Wishing you good health.

Reply Date: 2017/05/31

More Info

Pulsatile tinnitus, characterized by hearing rhythmic sounds that often coincide with one's heartbeat, can be a perplexing condition. In your case, the "thumping" sound in your right ear, particularly when someone speaks to your left ear, suggests a possible connection between auditory processing and the underlying vascular or muscular structures in your ear.
Given that you have already consulted multiple ENT specialists and undergone hearing tests without any significant findings, it is essential to consider other potential causes. Pulsatile tinnitus can arise from various factors, including vascular anomalies, muscle contractions, or even issues related to the Eustachian tube function.
1. Eustachian Tube Dysfunction: The Eustachian tube connects the middle ear to the back of the nose and helps equalize pressure. If this tube is not functioning properly, it can lead to a sensation of fullness or pressure in the ear, which might be perceived as a thumping sound, especially when there are changes in pressure, such as when someone speaks loudly or when you change positions.

2. Muscle Spasms: The muscles in the middle ear, particularly the tensor tympani and stapedius, can sometimes contract involuntarily, leading to sounds that might be perceived as thumping or clicking. This could explain why the sound occurs in response to specific stimuli, such as someone talking to you.

3. Vascular Issues: Pulsatile tinnitus can also be caused by blood flow changes in the vessels near the ear. Conditions such as arteriovenous malformations or increased blood flow due to physical exertion or stress can lead to this phenomenon.
4. Auditory Processing: Your observation that the sound occurs when someone speaks to your left ear may indicate a unique auditory processing issue. The brain's interpretation of sound can sometimes lead to unusual perceptions, especially if there is a slight imbalance in how sound is processed between the two ears.

5. Age-Related Changes: While some doctors may attribute these symptoms to aging, it is crucial to differentiate between normal age-related changes and those that could indicate an underlying issue. Age can affect the auditory system, but if the symptoms are bothersome or persistent, further investigation is warranted.

Given your situation, it may be beneficial to pursue additional evaluations. Here are some recommendations:
- Imaging Studies: Consider asking your doctor about imaging studies, such as an MRI or CT scan, to rule out any vascular anomalies or structural issues in the ear or surrounding areas.

- Neurological Evaluation: Since the auditory system is closely linked to neurological pathways, a consultation with a neurologist may provide insights into whether there are any neurological factors contributing to your symptoms.

- Allergy Testing: Although you mentioned that you rarely experience allergies, it might be worthwhile to undergo allergy testing to rule out any potential sensitivities that could be affecting your Eustachian tube function.

- Sound Therapy: If the pulsatile tinnitus is not indicative of a serious underlying condition, sound therapy or tinnitus retraining therapy may help manage the perception of sound and reduce its impact on your daily life.

In conclusion, while pulsatile tinnitus can be benign, it is essential to continue seeking answers, especially since it affects your quality of life. Keep a detailed log of when the symptoms occur, their duration, and any associated activities or environmental factors. This information can be invaluable for healthcare providers as they work to identify the underlying cause and develop an appropriate management plan.

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