Pulsatile Tinnitus: Causes, Symptoms, and Treatments

Bilateral tinnitus

Hello doctor, four years ago I had surgery for scoliosis, and a year later, for unknown reasons, I started experiencing muscle twitching, which has become more severe over the past three years.
I underwent examinations at Taichung Veterans General Hospital and China Medical University Hospital, both of which returned normal results.
Eventually, I received some improvement at a qualified traditional Chinese medicine clinic in Taichung, where the doctor indicated that my muscle elasticity and blood circulation were poor, advising me to be more active.
Since September, I have been taking prescribed medications, and recently, before last winter solstice, I noticed that when lying on my side, I could hear a thumping sound in both ears that resembled my heartbeat.
Sometimes, if my heart rate was faster, I felt like my ears were vibrating (though they weren't).
When my heart rate was more stable, I wouldn't hear the sound.
Initially, hearing the heartbeat was quite frightening.
The traditional Chinese medicine doctor mentioned that this situation was abnormal, and after researching "pulsatile tinnitus" online, I became increasingly anxious, worrying about potential issues with my brain or neck.
I planned to visit a major hospital for a detailed examination.
When trying to sleep, I began experiencing high-frequency tinnitus in both ears, which was extremely loud.
I had to take Rifampicin, which I had stopped for a long time, to get some sleep, but I woke up the next day with the same tinnitus.
I called the traditional Chinese medicine doctor, who confirmed that the medication could indeed cause tinnitus and advised me to stay active to promote blood circulation and avoid sitting down immediately.
However, feeling uneasy, I visited two hospitals for further examinations.
First, I went to Changhua County Hospital, where the doctor removed earwax from my right ear, but it did not improve my condition.
My hearing test was normal, and another test, which involved blocking my ears individually, also returned normal results.
An X-ray was normal as well.
The doctor prescribed vitamin B, medication for dizziness, and allergy medication for my nose.
That night, I only took vitamin B, but I woke up in the middle of the night with my left leg completely numb, so I stopped taking it.
A week later, I went to another major hospital for similar tests, where they noted slight damage to the high frequencies and prescribed medication for peripheral blood circulation.
No further tests were scheduled because I informed both doctors that I only experienced the heartbeat sound when lying on my side and did not have dizziness or headaches, so they did not recommend more detailed examinations.
Additionally, since my spinal surgery extended to my lower back, I sometimes cannot sit for long and tend to lie down.
Could this long-term position be contributing to my tinnitus? Thank you.

Emily, 30~39 year old female. Ask Date: 2018/01/22

Dr. Zheng Jueyi reply Otolaryngology

Hello, if most of the tests are normal, tinnitus is often associated with anxiety, insomnia, or high stress levels.
It is recommended to improve these aspects first.
If there is still no improvement, it is advisable to continue follow-up visits with an otolaryngologist for treatment.
Wishing you peace and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2018/01/22

More Info

Pulsatile tinnitus is a type of tinnitus characterized by hearing a rhythmic sound that often corresponds to the heartbeat. This condition can be quite distressing, as it may indicate underlying vascular or neurological issues. Understanding the causes, symptoms, and treatment options for pulsatile tinnitus is essential for managing this condition effectively.

Causes of Pulsatile Tinnitus
Pulsatile tinnitus can arise from various causes, including:
1. Vascular Issues: Abnormalities in blood vessels, such as arteriovenous malformations or vascular tumors, can lead to turbulent blood flow, which may be perceived as a rhythmic sound in the ears.

2. Increased Blood Flow: Conditions that increase blood flow to the head and neck, such as pregnancy, hyperthyroidism, or anemia, can also cause pulsatile tinnitus.

3. Middle Ear Conditions: Issues such as middle ear infections or Eustachian tube dysfunction can create a sensation of pulsatile sounds.

4. Muscle Spasms: Involuntary contractions of muscles in the middle ear can lead to pulsatile tinnitus.

5. Structural Abnormalities: Conditions such as atherosclerosis, where arteries become narrowed, can lead to increased turbulence in blood flow, resulting in pulsatile tinnitus.

Symptoms
The primary symptom of pulsatile tinnitus is hearing a rhythmic sound that often matches the heartbeat. This sound can be perceived in one or both ears and may vary in intensity. Patients may also experience:
- A sensation of fullness in the ear
- Hearing loss (in some cases)
- Increased anxiety or distress due to the persistent sound

Diagnosis
Diagnosing pulsatile tinnitus typically involves a thorough medical history and physical examination. Doctors may perform several tests, including:
- Hearing Tests: To assess any hearing loss.

- Imaging Studies: MRI or CT scans may be used to visualize the blood vessels and structures of the ear and brain.

- Blood Tests: To check for underlying conditions such as anemia or thyroid issues.

Treatment Options
Treatment for pulsatile tinnitus depends on the underlying cause. Some potential treatment options include:
1. Medical Management: If the tinnitus is due to a vascular issue, medications may be prescribed to manage blood flow or treat underlying conditions.

2. Surgical Interventions: In cases where a structural abnormality is identified, surgical options may be considered to correct the issue.

3. Sound Therapy: Using background noise or white noise machines can help mask the sound of tinnitus, making it less noticeable.

4. Cognitive Behavioral Therapy (CBT): This can help patients manage the emotional distress associated with tinnitus.

5. Lifestyle Modifications: Improving blood circulation through regular exercise, maintaining a healthy diet, and managing stress can be beneficial.

Conclusion
Given your history of scoliosis surgery and the subsequent development of pulsatile tinnitus, it is essential to continue seeking medical advice. While your recent evaluations have returned normal results, the persistence of symptoms warrants further investigation. It is possible that changes in posture or muscle tension due to your surgery may contribute to your symptoms.
Consulting with an ear, nose, and throat (ENT) specialist or a neurologist who can provide a comprehensive evaluation may be beneficial. They may recommend additional imaging studies or tests to rule out any vascular issues or other underlying conditions.
In the meantime, focusing on improving your overall health through physical activity and stress management may help alleviate some symptoms. Remember, it's crucial to communicate openly with your healthcare providers about your concerns and symptoms to ensure you receive the appropriate care.

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