Pulsatile Tinnitus: Causes and Consultations for Ear Sounds

Q: Pulsatile Tinnitus: Causes and Consultations for Ear Sounds

Hello： Generally speaking, if you hear a sound that is synchronized with your pulse and vascular abnormalities have been ruled out, it may indeed be the vascular pulse being transmitted to your ears. <br>The conduction of sound waves relies on a medium, and bones, muscles, and sk

Regular sounds in the left ear?

Hello Dr.
Hong,
I need to work on the computer for long periods.
Occasionally, I hear a chirping sound in my left ear that syncs with my pulse.
I have undergone carotid and intracranial ultrasounds twice (at different hospitals two years apart), and both doctors generally said that at my age of 57, there is no significant issue.
However, they did mention that my neck and shoulders are quite stiff and advised me to avoid prolonged forward neck positioning and to tuck in my chin.
The chirping sound that syncs with my pulse is likely a muscular issue, different from the whooshing sounds caused by vascular narrowing.
Recently, I have started hearing another type of sound in my left ear, similar to a tapping or dripping noise, like the sound of a watch when held close to the ear.
This sound is rhythmic but does not sync with my pulse.
Sometimes, the sound disappears when I turn my head.
The first chirping sound that syncs with my pulse occurs only occasionally, mostly when I am very tired.
The second dripping sound, which has only recently appeared, does not sync with my pulse and occurs sporadically, usually ringing a few times or disappearing when I turn my head.
An ear specialist has examined me and found no abnormalities.
I am considering going back to a neurologist but am concerned about being dismissed.
I would like to ask Dr.
Hong about other possible factors related to the symptoms mentioned above, and if there are any other specialties you would recommend consulting besides otolaryngology and neurology.
Previously, Dr.
Chang insisted that I do not need to undergo a cranial ultrasound again, while the physician at the base hospital suggested I could have it checked once a year (but I am unsure what condition to present).
Thank you, Dr.
Hong, for taking the time to clarify these concerns.

Mr. Zhang, 50~59 year old female. Ask Date: 2021/11/05

Dr. Hong Weibin reply Neurology

Hello: Generally speaking, if you hear a sound that is synchronized with your pulse and vascular abnormalities have been ruled out, it may indeed be the vascular pulse being transmitted to your ears.
The conduction of sound waves relies on a medium, and bones, muscles, and skin all serve as mediums.
If the neck is shorter, being closer to the heart and aorta, the pulsation of the blood vessels may be transmitted to the small auditory bones in the middle ear.
Additionally, there could be degeneration or structural abnormalities in the auditory nerve or ear canal.
It is also important to note whether this sound occurs continuously, intermittently, or only in quiet environments.
You should discuss potential causes with your physician, as some conditions may not necessarily be pathological and could be normal variations.
Just as people come in different heights and body types, we do not specifically label individuals of average build as normal while considering those who are tall or short as abnormal.
Transcranial Doppler ultrasound heavily relies on the technician's skill, and due to the obstruction by bone, the values obtained from adult transcranial ultrasound are only for reference.
If your symptoms remain unchanged after a period of observation, without becoming louder or lasting longer, you can feel more reassured.
For patients at risk of stroke or cardiovascular diseases (such as the elderly, those with hypertension, diabetes, hyperlipidemia, smokers, or those who are obese), we typically arrange for carotid ultrasound to monitor vascular sclerosis every 1-2 years.
Hong Wei-bin

Reply Date: 2021/11/05

More Info

Pulsatile tinnitus, characterized by hearing sounds that are in sync with the heartbeat, can be a perplexing condition. Your experience of hearing a "chirping" sound in your left ear that aligns with your pulse, along with the recent emergence of a "ticking" sound that is not synchronized with your heartbeat, raises several considerations.
Firstly, it is important to understand that pulsatile tinnitus can often be attributed to vascular issues, muscular tension, or even changes in the ear's anatomy. Given your age of 57 and the previous evaluations by two different physicians, it seems that they have ruled out significant vascular abnormalities, which is reassuring. The mention of "shoulder and neck stiffness" suggests that muscle tension could be contributing to your symptoms. Muscular tension in the neck and jaw can lead to changes in how sound is perceived, potentially causing or exacerbating tinnitus.

The "ticking" sound you describe, which occurs irregularly and sometimes disappears with head movement, could be related to several factors. One possibility is that it may be caused by Eustachian tube dysfunction, where the tube that connects the middle ear to the back of the throat does not open properly. This can lead to pressure changes in the ear, resulting in unusual sounds. Another possibility is that it could be related to the muscles in the ear, such as the tensor tympani or stapedius, which can contract and produce sounds that may be perceived as "ticking" or "clicking."
Since you have already consulted with an ear specialist and no abnormalities were found, it may be beneficial to explore other avenues. Consulting with a neurologist is a reasonable next step, especially if you have concerns about neurological factors contributing to your symptoms. Additionally, a physical therapist specializing in craniofacial or cervical issues may help address any muscular tension that could be affecting your ear.

In terms of further evaluations, if you are considering a follow-up with a neurologist, you might want to discuss the possibility of imaging studies, such as an MRI or CT scan, to rule out any structural issues that may not have been previously identified. However, it is essential to communicate your symptoms clearly and express your concerns about the potential causes of your tinnitus.

Lastly, lifestyle modifications can also play a significant role in managing tinnitus. Reducing stress, practicing good posture, and ensuring you take regular breaks from prolonged computer use can help alleviate some of the tension in your neck and shoulders. Additionally, mindfulness practices and relaxation techniques may provide some relief from the perception of tinnitus.

In summary, while your pulsatile tinnitus and the new ticking sound may be benign, it is crucial to continue seeking answers and exploring different specialties if your symptoms persist. Engaging with a neurologist and possibly a physical therapist could provide further insights and management strategies. Remember to advocate for your health and ensure that your concerns are taken seriously by your healthcare providers.

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