Pulsatile Tinnitus: Causes and Solutions for Ear Noises

There is a thumping sound in the ear?

Hello Doctor: Recently, when I lie down to sleep, I hear a thumping sound in my right ear, like a drumming noise, somewhat resembling an abnormal electrical discharge.
The thumping is irregular; initially, it occurred infrequently, but now it happens every time I lie down to sleep.
This has been troubling me for a long time, making it difficult to sleep well.
It has been nearly six months since this started.
I have undergone a hearing test, which showed no issues.
The sound feels like a piston suddenly opening in my right ear, followed by a wave-like sound, and then a series of thumping noises that gradually increase in volume.
However, when I swallow or change positions, the sound temporarily disappears, but after a while, the thumping returns.

Xiang Ping, 20~29 year old female. Ask Date: 2018/03/07

Dr. Ji Zhaoyun reply Otolaryngology

Hello, regarding your question, it is possible that you are experiencing: 1) Eustachian tube dysfunction: This is the most common cause and can occur not only during activities such as flying, climbing, or diving, but also when forcefully blowing your nose or bending over.
2) Sudden sensorineural hearing loss.
3) Otitis media: a) Acute otitis media: Often occurs alongside upper respiratory infections (such as colds) and sinusitis, and in severe cases, may lead to ear discharge.
b) Chronic otitis media with acute exacerbation: This typically occurs when there is a pre-existing perforation in the eardrum, which can become inflamed due to contaminated water or improper ear cleaning.
All of the above conditions can be appropriately managed with medication through medical consultation.
If you have already undergone pure tone audiometry (which requires headphones in a soundproof booth, where you respond to sounds by pressing a button, rather than just using a tuning fork), and it has been confirmed that you do not have sudden sensorineural hearing loss, then medication may suffice.
However, if you have not had a pure tone audiometry test, it is advisable to visit a hospital for evaluation to rule out sudden hearing loss.
The golden treatment window for sudden sensorineural hearing loss is two weeks, and early treatment yields better outcomes.
Wishing you safety and health.
Sincerely, Dr.
Chi Chao-Yun, Head of the ENT Department, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2018/03/07

More Info

Pulsatile tinnitus, characterized by hearing rhythmic sounds in sync with your heartbeat, can be a perplexing and distressing condition. Your description of experiencing a "thumping" or "drumming" sound in your right ear, particularly when lying down, suggests that this may be a case of pulsatile tinnitus. This condition can arise from various underlying causes, and understanding these can help guide you toward effective solutions.

Possible Causes of Pulsatile Tinnitus
1. Vascular Issues: Pulsatile tinnitus is often linked to blood flow changes in the vessels near the ear. Conditions such as arteriovenous malformations, vascular tumors, or even increased blood flow due to exercise or anxiety can lead to this phenomenon. The sound you hear may be the blood flow through these vessels, which can become more pronounced when lying down due to changes in blood pressure and circulation.

2. Middle Ear Problems: Issues within the middle ear, such as Eustachian tube dysfunction, can cause pressure changes that might lead to pulsatile tinnitus. The Eustachian tube helps equalize pressure in the middle ear, and if it is not functioning properly, it can create sensations of fullness or sound.

3. Muscle Spasms: Sometimes, spasms in the muscles around the ear can create sounds that mimic pulsatile tinnitus. This can happen due to stress, fatigue, or even certain medications.

4. Increased Awareness: In some cases, individuals may become more aware of their bodily sounds, including blood flow, especially in quiet environments or when lying down. This heightened awareness can make normal physiological sounds seem more pronounced.

Diagnosis and Evaluation
Given that you have already undergone a hearing test with normal results, it may be beneficial to pursue further evaluation. Here are some steps you can take:
- Consult an Ear, Nose, and Throat (ENT) Specialist: An ENT can perform a thorough examination, including imaging studies like an MRI or CT scan, to rule out any vascular abnormalities or structural issues in the ear.

- Evaluate Blood Flow: A Doppler ultrasound may be recommended to assess blood flow in the vessels near the ear. This can help identify any vascular causes of your symptoms.

- Consider a Neurological Evaluation: If vascular causes are ruled out, consulting a neurologist may be beneficial to explore other potential neurological conditions that could contribute to your symptoms.

Management Strategies
While the underlying cause is being investigated, there are several strategies you can employ to manage your symptoms:
1. Sound Therapy: Using background noise, such as white noise machines or soft music, can help mask the sound of pulsatile tinnitus, making it less noticeable, especially at night.

2. Cognitive Behavioral Therapy (CBT): Engaging in CBT can help you develop coping strategies to manage the distress caused by tinnitus. This therapy focuses on changing negative thought patterns and reducing anxiety related to the condition.

3. Lifestyle Modifications: Reducing caffeine and alcohol intake, managing stress through relaxation techniques, and ensuring adequate sleep can help alleviate symptoms.

4. Eustachian Tube Exercises: If Eustachian tube dysfunction is suspected, performing exercises such as the Valsalva maneuver (gently blowing with your mouth closed and nose pinched) can help equalize pressure in the ears.

5. Medication: In some cases, medications may be prescribed to address underlying conditions or to help manage anxiety and stress that may exacerbate tinnitus.

Conclusion
Pulsatile tinnitus can be a complex condition with various potential causes. It is crucial to work closely with healthcare professionals to identify the underlying issue and develop an appropriate management plan. By addressing both the physical and psychological aspects of your symptoms, you can improve your quality of life and find relief from the distressing sounds you are experiencing. If your symptoms persist or worsen, do not hesitate to seek further medical advice.

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