Pulsatile Tinnitus: Causes and Management Strategies

Regarding pulsatile tinnitus, also known as vascular tinnitus?

Hello, Dr.
Jiang.

1.
I have been experiencing tinnitus (various sounds, primarily a distant roaring noise, usually in the left ear, with a very rare occurrence of a sudden long beep in the right ear that gradually diminishes to normal, while the left ear continues with the roaring sound) for many years.

2.
In the past three years, I occasionally experience a pulsatile tinnitus in my left ear, which sounds like a rhythmic "ticking" that follows my heartbeat.
This usually occurs when I have poor sleep, feel fatigued, or after long periods of computer use.
Cardiologists and neurologists have examined me and indicated that there are no vascular abnormalities causing this sound.

3.
I was diagnosed with Meniere's disease 27 years ago, and medication only alleviated the symptoms.
After ten years, I suddenly returned to normal.
However, eight years ago, I had a myocardial infarction, and three months after discharge, I experienced vertigo again.
I consulted a neurologist who prescribed me Difenidol and Cinarizine.
After a year of medication, the vertigo occurred only occasionally, but I often felt dizzy all day, similar to having a cold.
In the past two years, I sometimes feel normal for two to three months, followed by two to three months of dizziness.

4.
The main issue I want to address is that about six months ago and again today, I experienced a continuous "tapping" sound in my left ear.
This sound does not coincide with my pulse but is a series of quicker sounds that pause and then resume, which is different from the pulsatile sound mentioned in point 1.
Regarding issue 3, I underwent a carotid ultrasound, and the doctor stated that based on the transcranial Doppler, there was no significant narrowing (less than 25%).
I was advised to continue taking aspirin as prescribed by my cardiologist.
For over seven years, my doctor has insisted that no follow-up examinations are necessary.
Last December, I visited another hospital for a transcranial Doppler, and comparing it to data from seven years ago, the doctor mentioned that while it is difficult to describe the exact percentage of narrowing, at my age of 57, it is considered very mild.
This could be attributed to the medication from my cardiologist and my attention to diet or other factors, and I was told not to worry, with no medication prescribed.

I initially felt relieved after undergoing two transcranial Dopplers and my mood improved significantly, alleviating my worries.
However, I was surprised when the strange sound from issue 4 appeared today.
I found some information online that was quite vivid, and I am a bit concerned about whether I should return to see a neurologist or another specialist.
I apologize for the lengthy message and would greatly appreciate your insights, Dr.
Jiang.
Thank you.

Mr. Zhang, 50~59 year old female. Ask Date: 2021/02/13

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it seems to be a vascular-related issue, but the instruments can only detect large blood vessels.
You have a history of myocardial infarction and some neurological symptoms.
It may be necessary to consider obstructive sleep apnea: if you have this condition, it can lead to daytime concentration difficulties and frequent drowsiness.

Obstructive sleep apnea is the most common type, accounting for about 90% of patients in this category.
Soft tissue near the throat obstructs the airway, making the upper airway narrower, which in turn causes snoring and breathing cessation.
Abnormalities in upper airway structure, excessive relaxation of airway muscles, and obesity are also common triggers.
Patients with this condition are prone to increased cardiovascular strain due to sleep interruptions and hypoxia, making them more susceptible to cardiovascular diseases such as hypertension, arrhythmias, coronary artery disease, myocardial infarction, heart failure, and stroke.
Clinically, patients with poorly controlled conditions like diabetes and hypertension often have underlying sleep apnea syndrome.

I recommend that you consult a sleep medicine specialist to discuss testing and treatment.
Wishing you good health and peace.

Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2021/02/13

More Info

Pulsatile tinnitus is a type of ear ringing that is often described as a rhythmic sound that coincides with the heartbeat. This condition can be particularly distressing, as it may indicate underlying vascular issues or other health concerns. Understanding the causes and management strategies for pulsatile tinnitus is essential for effective treatment and relief.

Causes of Pulsatile Tinnitus
Pulsatile tinnitus can arise from various factors, including:
1. Vascular Abnormalities: Conditions such as arteriovenous malformations, vascular tumors, or abnormalities in blood vessels near the ear can lead to pulsatile tinnitus. These abnormalities may create turbulent blood flow, which can be perceived as sound.

2. Increased Blood Flow: Situations that increase blood flow, such as pregnancy, anemia, or hyperthyroidism, can lead to pulsatile tinnitus. The increased blood flow can amplify the sounds of blood moving through the vessels.

3. Middle Ear Conditions: Issues within the middle ear, such as Eustachian tube dysfunction or otitis media, can also contribute to pulsatile tinnitus. These conditions can affect how sound is transmitted and perceived.

4. Muscle Spasms: In some cases, muscle spasms in the middle ear can create a rhythmic sound that resembles pulsatile tinnitus. This is often referred to as "muscle tinnitus."
5. Other Medical Conditions: Conditions such as Meniere's disease, which you mentioned having experienced, can also lead to various auditory symptoms, including pulsatile tinnitus.

Management Strategies
Managing pulsatile tinnitus involves a multifaceted approach:
1. Medical Evaluation: Since you have already consulted with both cardiologists and neurologists, it is crucial to continue seeking medical advice if your symptoms change or worsen. A thorough evaluation, including imaging studies like MRI or CT scans, may be necessary to rule out any serious underlying conditions.

2. Sound Therapy: Many patients find relief through sound therapy, which involves using background noise or white noise to mask the tinnitus sounds. This can help distract from the pulsatile tinnitus and make it less noticeable.

3. Cognitive Behavioral Therapy (CBT): CBT can be beneficial for individuals struggling with the emotional impact of tinnitus. This therapy helps patients develop coping strategies and reduce anxiety related to their symptoms.

4. Lifestyle Modifications: Managing stress, ensuring adequate sleep, and avoiding stimulants like caffeine can help reduce the severity of tinnitus symptoms. Since you mentioned that your symptoms worsen with fatigue or prolonged computer use, taking regular breaks and practicing relaxation techniques may be beneficial.

5. Medication: In some cases, medications may be prescribed to address underlying conditions contributing to tinnitus. For example, if blood flow issues are suspected, medications that improve circulation may be considered.

6. Follow-Up Care: Regular follow-up with your healthcare providers is essential, especially if you have a history of cardiovascular issues or other related conditions. Keeping track of your symptoms and any changes can help your doctors make informed decisions about your care.

Conclusion
Pulsatile tinnitus can be a complex condition with various underlying causes. Given your history of Meniere's disease and cardiovascular concerns, it is essential to maintain open communication with your healthcare providers. If you experience new or worsening symptoms, do not hesitate to seek further evaluation. Understanding your condition and exploring management strategies can significantly improve your quality of life and reduce the distress associated with pulsatile tinnitus.

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