Pulsatile Tinnitus: Causes, Symptoms, and Treatment Options

Q: Pulsatile Tinnitus: Causes, Symptoms, and Treatment Options

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. <br>2) Vascular issues. <br>3) Otitis media： a) Ac

Pulsatile tinnitus in the right ear?

Right ear unilateral pulsatile tinnitus started with low-frequency swirling sounds, now it's high-frequency pain in the right ear, which has also spread to the left ear.
I experience headaches that shift from side to side, and my left ear hurts every day.
I've had EEGs, MRIs, hearing tests, and the ENT doctor examined my mouth and neck, prescribing ear drops for me.
I can't see my ear canal; what happens if the ear drops touch the ear canal? After using them for 2-3 days, I felt little effect, so I stopped.
I often have nasal congestion at night, and during winter, I wake up needing a whole box of tissues every day.
Now my left ear hurts a lot, which it didn't before, and now even inside my left ear is painful.
Recently, before the pulsatile tinnitus started, I used to clean my ears daily, finding it very comfortable and relieving stress, but now I don't dare to do it! Doctor: What could this situation be? Could it be nasal cancer? Have you encountered patients similar to me? I have autonomic nervous system dysregulation, and I smoked from age 19 to 41, quitting for 1-2 years recently.
I also chewed betel nut for two years when I was younger! What could be causing the pain in my ears? What should I do? The pulsatile tinnitus has changed; sometimes I can't hear my heartbeat, only a single high-frequency sound! Sometimes it comes back! Why is this happening? I'm feeling a bit crazy! Recently, the health center referred me to a psychiatrist, saying I seem a bit anxious and panicky.
Sometimes when I cook, I feel tightness in my chest and can't breathe; it happens quite often.
Once while driving, I felt like I couldn't breathe and wanted to stop the car and scream! My ear hurts, with daily pulsatile pain on the right side, and daily headaches—what does this mean? Please help me understand, thank you! I am very grateful! Recently, I felt like I was close to death, almost every day feeling like I was dying! I've had X-rays from the health center, chest X-rays, orthopedic X-rays, and colon X-rays, one each month, and now EEGs and MRIs!

Lin Xin-Yi, 40~49 year old female. Ask Date: 2022/07/07

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) Vascular issues.
3) Otitis media: a) Acute otitis media: Often occurs alongside upper respiratory infections (such as colds) and sinusitis, and in severe cases, there may be ear discharge.
b) Chronic otitis media with acute exacerbation: This usually occurs when there is a pre-existing perforation in the eardrum, which can be caused by contaminated water or improper ear cleaning, leading to inflammation.
All of the above conditions can be appropriately treated with medication through medical consultation.
It is advisable to undergo a pure tone audiometry test (which requires headphones in a soundproof booth, where you will press a button in response to sounds, rather than just using a tuning fork) or other relevant examinations.
Wishing you safety and good health.

Reply Date: 2022/07/07

More Info

Pulsatile tinnitus is a type of ear ringing that is often perceived as a rhythmic sound that matches the heartbeat. It can be particularly distressing, as it is not just a sound but can also be accompanied by pain and other symptoms, as you've described. The condition can arise from various causes, and understanding these can help in managing the symptoms and addressing any underlying issues.

Causes of Pulsatile Tinnitus
1. Vascular Issues: Pulsatile tinnitus is frequently associated with vascular conditions. This includes abnormalities in blood vessels near the ear, such as arteriovenous malformations or vascular tumors. Increased blood flow or turbulence in the blood vessels can create the perception of sound in the ear.

2. Middle Ear Conditions: Conditions affecting the middle ear, such as Eustachian tube dysfunction or middle ear infections, can also lead to pulsatile tinnitus. These conditions can cause pressure changes that may affect how sound is perceived.

3. Neurological Factors: Issues related to the nervous system, including conditions like multiple sclerosis or acoustic neuromas, can also contribute to tinnitus.
4. Muscle Spasms: Involuntary contractions of the muscles in the middle ear can create sounds that may be perceived as tinnitus.

5. Sinus Issues: Given your symptoms of nasal congestion and frequent headaches, sinusitis or other sinus-related issues could be contributing to your ear pain and tinnitus. The sinuses are closely connected to the ear, and inflammation or pressure in the sinuses can affect ear function.

Symptoms and Associated Conditions
You mentioned experiencing pain in both ears, headaches, and feelings of anxiety. These symptoms can be interconnected. For instance, chronic pain can lead to anxiety and stress, which can exacerbate the perception of tinnitus. Additionally, the discomfort in your ears and the sensation of pulsatile tinnitus can lead to increased anxiety, creating a cycle that can be difficult to break.

Treatment Options
1. Medical Evaluation: Since you've undergone various imaging studies and evaluations, it's important to follow up with an ear, nose, and throat (ENT) specialist if you haven't already. They can provide a more focused examination of your ear and surrounding structures.

2. Management of Underlying Conditions: Addressing any sinus issues or infections may help alleviate your symptoms. If you have allergies or chronic sinusitis, managing these conditions can reduce inflammation and pressure.

3. Sound Therapy: Some patients find relief through sound therapy, which involves using background noise to mask the tinnitus. This can help reduce the perception of the ringing or pulsing sound.

4. Cognitive Behavioral Therapy (CBT): Given your feelings of anxiety and panic, CBT can be beneficial. It helps patients develop coping strategies to manage the emotional response to tinnitus.

5. Lifestyle Modifications: Reducing caffeine and nicotine intake, managing stress, and ensuring adequate sleep can also help in managing tinnitus symptoms.

6. Medications: In some cases, medications may be prescribed to help manage anxiety or pain, which can indirectly help with tinnitus.

Conclusion
Pulsatile tinnitus can be a complex condition with multiple contributing factors. It is essential to work closely with healthcare professionals to identify the underlying causes and develop a comprehensive treatment plan. Given your symptoms of ear pain, headaches, and anxiety, a multidisciplinary approach involving ENT specialists, neurologists, and mental health professionals may be beneficial.
If you continue to experience significant distress or if your symptoms worsen, do not hesitate to seek immediate medical attention. Your health and well-being are paramount, and addressing these symptoms early can lead to better outcomes.

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