Pulsatile Tinnitus: Causes and When to Seek Help

There is a ringing sound in the ear?

Hello: For the past week, I have been experiencing intermittent tinnitus that sounds like a drum in my ear.
I do not have nasal congestion and do not feel like I have a cold, but I have been experiencing pain in my upper back.
Last night, the condition worsened as the drumming sound accompanied me to sleep, and I woke up in the middle of the night with the sound still present.
This morning, it has slightly eased but continues intermittently.
I am unsure what kind of examination I should undergo.

jane, 40~49 year old female. Ask Date: 2003/01/22

Dr. Ye Dawei reply Otolaryngology

Hello Jane.
You can visit the outpatient clinic for a basic examination of the ear, nose, and throat, as well as a hearing test.
Please take the time to come to our ENT department for a detailed examination.
I am providing the previous message for your reference.

Reply Date: 2003/01/22

More Info

Pulsatile tinnitus is a type of ear ringing that is characterized by a rhythmic sound that often coincides with the heartbeat. Unlike regular tinnitus, which can manifest as a constant ringing or buzzing sound, pulsatile tinnitus is typically described as a whooshing or thumping noise that can be quite distressing. Understanding the causes of pulsatile tinnitus and knowing when to seek medical help is crucial for effective management and treatment.

Causes of Pulsatile Tinnitus
Pulsatile tinnitus can arise from various underlying conditions, often related to blood flow or vascular issues. Some common causes include:
1. Vascular Abnormalities: Conditions such as arteriovenous malformations (AVMs) or vascular tumors can lead to abnormal blood flow, resulting in pulsatile tinnitus.

2. Increased Blood Flow: Situations that increase blood flow, such as pregnancy, anemia, or hyperthyroidism, can cause pulsatile tinnitus. The increased blood flow can create turbulence that is perceived as sound.

3. Middle Ear Conditions: Issues within the middle ear, such as otosclerosis or Eustachian tube dysfunction, can also contribute to the perception of pulsatile tinnitus.

4. Head and Neck Conditions: Tumors or other abnormalities in the head and neck region, including the jugular bulb or carotid artery, can lead to pulsatile tinnitus.

5. Intracranial Hypertension: Increased pressure within the skull can affect the auditory pathways and lead to pulsatile tinnitus.

When to Seek Help
Given your symptoms, including the rhythmic sound in your ear and associated upper back pain, it is advisable to seek medical attention. Here are some indicators that warrant a visit to a healthcare professional:
- Persistent Symptoms: If the pulsatile tinnitus continues for more than a few days or worsens, it is essential to consult a doctor.

- Associated Symptoms: If you experience additional symptoms such as hearing loss, dizziness, or headaches, these could indicate a more serious underlying condition.

- Pain: The upper back pain you mentioned could be related or separate, but it is essential to discuss all symptoms with your healthcare provider.

Diagnostic Approach
When you visit a healthcare provider, they may perform a thorough evaluation, which could include:
- Physical Examination: A complete ear, nose, and throat (ENT) examination to assess for any visible abnormalities.

- Imaging Studies: Depending on the findings, imaging studies such as an MRI or CT scan may be necessary to evaluate the blood vessels and structures in the head and neck.

- Hearing Tests: Audiometric tests may be conducted to assess your hearing and determine if there is any associated hearing loss.

Treatment Options
The treatment for pulsatile tinnitus largely depends on the underlying cause. If a specific condition is identified, addressing that condition may alleviate the tinnitus. Some potential treatment options include:
- Medications: If the tinnitus is related to a vascular issue, medications to manage blood flow or reduce inflammation may be prescribed.

- Surgery: In cases where a structural abnormality is identified, surgical intervention may be necessary to correct the issue.

- Sound Therapy: For some individuals, sound therapy or hearing aids can help mask the sound of tinnitus and make it less bothersome.

In conclusion, pulsatile tinnitus can be a complex condition with various potential causes. Given your symptoms, it is essential to seek medical evaluation to determine the underlying cause and appropriate treatment. Early intervention can lead to better outcomes and improved quality of life.

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