Pulsatile Tinnitus: Symptoms and Next Steps for Relief

Pulsatile tinnitus in the right ear every night?

I experience daily headaches, and at night, my feet feel numb up to my calves.
My elbows and hands also go numb twice.
At night, I feel something strange with my heart.
When I measured my blood pressure, it was 96/52 with a heart rate of 71 on the right arm, 90/53 with a heart rate of 71 on the left, 87/50 with a heart rate of 72 on the right, 87/54 with a heart rate of 71 on the left, 88/47 with a heart rate of 67 on the right, and 89/50 with a heart rate of 69 on the left.
Last year, I had an EEG done, and the China Medical University diagnosed me with autonomic nervous system dysfunction.
The pediatrician also mentioned autonomic nervous system dysfunction.
I have seen a neurologist three times and a cardiologist twice.
The cardiologist confirmed that my heart is in excellent condition.
A cardiologist in China performed an electromyogram and a 24-hour Holter monitor, both showing no abnormalities.
This year, I visited a pulmonologist and an orthopedic specialist, and I have been experiencing pulsatile tinnitus every night.
I had an EEG and MRI, both of which were normal, but now I need to schedule a vascular angiogram.
I have a young child at home, and hospitalization poses risks.
The last time I had heavy menstrual bleeding, I went to get medication and didn't want to undergo any procedures.
I also saw an ENT specialist, who confirmed my hearing is normal and suggested I go to a larger hospital with better equipment.
The neurologist referred me back to the ENT specialist.
Am I dying? My head hurts so much.
If I have a neck ultrasound, can it replace the need for a vascular angiogram? Doctor, based on your experience, have you encountered similar cases? What should I do? Sincerely, a concerned individual.

Lin Xin-Yi, 40~49 year old female. Ask Date: 2022/06/06

Dr. Jiang Junyi reply Neurology

Dear Miss Lin,
You mentioned that you are experiencing "numbness in the soles of your feet extending to your calves, and numbness from your elbows to your palms." It is advisable to consult a neurologist to rule out peripheral nerve issues.

Regarding your symptoms of "daily headaches and pulsatile tinnitus every night," you have undergone EEG and MRI without any issues, but you may need to consider a vascular imaging study.
Your symptoms may suggest chronic migraine, which is defined as having headaches for more than three months, occurring on more than 15 days per month, lasting over four hours each day, with at least eight of those days diagnosed as migraines.
Migraines are classified as a type of primary headache, with causes stemming from trigeminal nerve sensitization and neurogenic inflammation of cerebral blood vessels.
The treatment for chronic migraines primarily involves two types of medications: preventive and acute treatments.
Oral preventive medications include serotonin agonists, antiepileptic drugs, beta-blockers, calcium channel blockers, or antidepressants, which should be taken for at least six months.
Given that you have consulted various specialties and the information is quite fragmented, I recommend seeking care at a nearby hospital with an emergency department to consolidate your medical information in one place.
Please ensure to practice self-protection and maintain cleanliness and disinfection before and after your medical visits.

Thank you for your inquiry, and feel free to discuss any related questions further! Wishing you good health, safety, and happiness.
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2022/06/06

More Info

Pulsatile tinnitus is a condition characterized by hearing a rhythmic sound in the ears that often coincides with the heartbeat. It can be distressing and may be associated with various underlying health issues. Given your symptoms, including daily headaches, limb numbness, and fluctuating blood pressure readings, it’s understandable to feel overwhelmed and concerned about your health.

Firstly, it's important to recognize that pulsatile tinnitus can arise from several causes, including vascular issues, ear-related problems, or even neurological conditions. The fact that you have undergone multiple evaluations, including brain wave tests, MRIs, and heart monitoring, is a positive step in ruling out serious conditions. Your normal heart evaluations suggest that your heart is functioning well, which is reassuring.

The symptoms you describe, such as numbness in your limbs and fluctuating blood pressure, may be indicative of autonomic nervous system dysregulation, which you mentioned has been diagnosed previously. This condition can lead to a variety of symptoms, including dizziness, headaches, and changes in blood pressure. It’s crucial to manage stress and anxiety, as these can exacerbate symptoms of autonomic dysfunction.

Regarding your question about whether a neck ultrasound could replace a vascular angiogram, it’s essential to understand that these tests serve different purposes. A neck ultrasound can provide information about blood flow and the condition of the carotid arteries, but it may not give a complete picture of vascular health compared to an angiogram, which provides detailed images of blood vessels. If your physician recommends an angiogram, it is likely to rule out any significant vascular issues that could be contributing to your pulsatile tinnitus.

In terms of next steps for relief, consider the following:
1. Consultation with Specialists: Since you have seen various specialists, it may be beneficial to have a coordinated approach. A neurologist, an ear, nose, and throat (ENT) specialist, and possibly a vascular specialist could work together to provide a comprehensive evaluation.

2. Stress Management: Techniques such as mindfulness, yoga, or cognitive behavioral therapy can help manage stress and anxiety, which may alleviate some of your symptoms.

3. Lifestyle Modifications: Ensure you are maintaining a healthy diet, staying hydrated, and getting adequate sleep. Regular physical activity can also help improve overall well-being and may reduce some symptoms.

4. Medication Review: If you are on any medications, discuss with your doctor whether they could be contributing to your symptoms. Sometimes, adjusting dosages or switching medications can lead to improvements.

5. Follow-Up Testing: If your symptoms persist or worsen, follow up with your healthcare provider about further testing. This may include the vascular imaging you mentioned or other diagnostic tests to explore the underlying causes of your symptoms.

6. Support Systems: Engage with support groups or communities where you can share experiences and coping strategies with others facing similar challenges.

In conclusion, while pulsatile tinnitus and your other symptoms can be concerning, it’s essential to approach the situation methodically and collaboratively with your healthcare team. Keep advocating for your health, and don’t hesitate to seek further opinions if you feel your concerns are not being addressed adequately. Your well-being is paramount, and with the right support and management, there is hope for relief from your symptoms.

Similar Q&A

Understanding Pulsatile Tinnitus: Causes and Management Strategies

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 roar...

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 thi...

Persistent Right Ear Pain and Pulsatile Tinnitus: Seeking Solutions

I am 166.5 cm tall and weigh 72 kg. I experience pulsatile tinnitus in my right ear every night. Initially, it was a low-frequency whirl, but now it has become a high-frequency single tone. My right ear hurts daily, and sometimes I feel numbness on the right side of my head. I ha...

Dr. Zheng Jueyi reply Otolaryngology
Hello: It is difficult to determine. If the symptoms persist without improvement, it is recommended to return for a medical examination and evaluation. Wishing you safety and health. Sincerely, Dr. Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan General Hospit...

Understanding Pulsatile Tinnitus: Causes and Next Steps for Diagnosis

Hello Doctor, I would like to ask about a situation that began last Friday when I started experiencing a persistent ringing in my left ear. I have a history of allergic rhinitis, so I first visited a nearby otolaryngologist. The doctor asked me to perform a maneuver where I pin...

Dr. Ji Zhaoyun reply Otolaryngology
Hello, the issues you mentioned could be due to: 1) Eustachian tube dysfunction: This is the most common cause and can occur not only during flying, climbing, or diving, but also when forcefully blowing your nose or bending over. 2) Sudden sensorineural hearing loss. 3) Otitis me...

Understanding Pulsatile Tinnitus: Causes and Solutions for Ear Issues

I have always experienced a common type of tinnitus, characterized by a buzzing or ringing sound in my ears. However, a few years ago, I began to hear a sound in my right ear that resembles blood flow, similar to what one might hear during a vascular ultrasound. This sound is par...

Dr. Zheng Jueyi reply Otolaryngology
Hello: If multiple examinations have returned normal results and there are no better management options, it is still recommended to try to ignore it as much as possible through distraction or redirection of attention. Wishing you peace and health. Sincerely, Dr. Cheng Jue-Yi, Dir...