Pulsatile Tinnitus: Causes and When to Seek Help

Q: Pulsatile Tinnitus: Causes and When to Seek Help

Hello, Ms. <br>Tsai：<br>You mentioned that "only the left ear, and it synchronizes exactly with the heartbeat, almost always heard before or after showering," which suggests paroxysmal pulsatile tinnitus. <br>This may be primarily due to Eustachian tube dysfunction. <br>The Eusta

Tinnitus?

Hello, Doctor.
I would like to inquire about a recent issue where I hear a whooshing sound in my left ear that matches the rhythm of my heartbeat.
This occurs only in my left ear and is almost always heard before or after showering, lasting for about an hour or more.
Could you please explain the possible reasons for this? If I need to undergo further examination at the hospital, should I see a neurologist? Thank you, Doctor!

Cai, 20~29 year old female. Ask Date: 2022/04/07

Dr. Jiang Junyi reply Neurology

Hello, Ms.
Tsai:
You mentioned that "only the left ear, and it synchronizes exactly with the heartbeat, almost always heard before or after showering," which suggests paroxysmal pulsatile tinnitus.
This may be primarily due to Eustachian tube dysfunction.
The Eustachian tube connects the nasal cavity to the middle ear and serves as an air passage to maintain pressure within the middle ear.
Due to nasal allergies or rhinitis, the mucosa inside the Eustachian tube may become swollen and come into contact with each other.
Since sound travels faster through solids and liquids than through air, you may hear the sound of your heartbeat.

If the tinnitus is caused by vascular abnormalities, it could stem from conditions such as arterial stenosis, aneurysm, dissection, atherosclerosis, or arteriovenous malformations, which typically present as continuous tinnitus.
I recommend that you first visit an otolaryngology clinic, and then consider follow-up examinations with a neurologist.
However, due to the recent increase in COVID-19 cases, please ensure to practice self-protection, maintain cleanliness, and adhere to preventive measures before and after your medical visits.
Thank you for your inquiry.
If you have further questions, feel free to discuss them! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2022/04/07

More Info

Pulsatile tinnitus is a type of tinnitus where the sound you hear in your ear is in sync with your heartbeat. This condition can be quite concerning, especially when it appears suddenly or is persistent, as it may indicate underlying vascular or neurological issues. In your case, the fact that you are experiencing this sound only in your left ear and that it coincides with your heart rate is significant.

There are several potential causes of pulsatile tinnitus. One common cause is increased blood flow in the vessels near the ear, which can occur due to various factors such as exercise, anxiety, or even hormonal changes. Other causes may include vascular malformations, such as arteriovenous malformations (AVMs), or conditions that affect the blood vessels, such as atherosclerosis. In some cases, pulsatile tinnitus can be related to increased intracranial pressure or even tumors that affect the blood vessels in the head and neck region.

Given that your symptoms occur primarily before or after showering, it’s worth considering that changes in blood pressure or blood flow during these times could be contributing factors. The warm water from the shower may cause blood vessels to dilate, leading to increased blood flow and the perception of pulsatile sounds in your ear.

When it comes to seeking medical help, it is advisable to start with an appointment with an ear, nose, and throat (ENT) specialist, rather than a neurologist. An ENT specialist can perform a thorough examination of your ears and assess for any potential ear-related issues that could be causing the pulsatile tinnitus. They may also conduct imaging studies, such as an MRI or CT scan, to evaluate the blood vessels and structures around your ear and brain.

If the ENT specialist rules out ear-related causes, they may refer you to a neurologist for further evaluation, especially if there are concerns about neurological conditions or if the pulsatile tinnitus is accompanied by other symptoms such as headaches, dizziness, or changes in vision.

In summary, pulsatile tinnitus can be caused by a variety of factors, and it is essential to seek medical evaluation to determine the underlying cause. Starting with an ENT specialist is a good approach, as they can provide a comprehensive assessment and guide you through the necessary steps for diagnosis and treatment. If you notice any changes in your symptoms or if they worsen, do not hesitate to seek medical attention promptly.

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