Pulsatile Tinnitus: Causes, Symptoms, and Next Steps

Once, when I squatted down and stood up, I experienced a rapid popping sound in my left ear?

I have been experiencing pulsatile tinnitus in my right ear every night for the past six months.
It is a high-pitched tone that I can only hear when I am sleeping.
I have undergone EEG and MRI scans, as well as hearing tests.
I also feel pain in my ear every day.
Could this be nasopharyngeal cancer or oropharyngeal cancer? I have a habit of cleaning my ears 3 to 4 times a day and also frequently pick my nose.
What kind of examinations should I undergo given my situation? Have there been similar cases among patients you have treated over the years? Sometimes at night, I experience nasal congestion on both sides, and during winter, I have a runny nose that drips clear fluid like a faucet, which can use up an entire box of tissues.
Please provide me with some guidance!

Lin Xin-Yi, 40~49 year old female. Ask Date: 2022/07/29

Dr. Li Jiaxuan reply Otolaryngology

Could you please tell me if there were any abnormalities found during the EEG MRI, hearing tests, or when the mouth was opened to palpate the neck? If not, it is usually suspected to be rhinitis or sinusitis, and for vascular ear nerve inflammation, it is recommended to proceed with a nasal endoscopy at the ENT clinic or undergo cerebral angiography.
Wishing you good health.

Reply Date: 2022/07/29

More Info

Pulsatile tinnitus is a type of ear ringing that is characterized by a rhythmic sound that often coincides with the heartbeat. This condition can be quite distressing, especially when it persists over an extended period, as in your case of six months. Understanding the underlying causes, symptoms, and potential next steps is crucial for managing this condition effectively.

Causes of Pulsatile Tinnitus
Pulsatile tinnitus can arise from various underlying conditions. Some common causes include:
1. Vascular Issues: Abnormal blood flow in the vessels near the ear can lead to pulsatile tinnitus. This could be due to conditions such as arteriovenous malformations, vascular tumors, or increased blood flow due to conditions like anemia or hyperthyroidism.

2. Middle Ear Conditions: Issues such as middle ear infections or Eustachian tube dysfunction can also contribute to pulsatile tinnitus. The Eustachian tube helps equalize pressure in the ear, and dysfunction can lead to a sensation of fullness or pressure, which may be perceived as pulsatile sounds.

3. Intracranial Pressure Changes: Conditions that affect the pressure within the skull, such as idiopathic intracranial hypertension, can also lead to pulsatile tinnitus.

4. Muscle Spasms: In some cases, spasms of the muscles in the middle ear can create a rhythmic sound that is perceived as pulsatile tinnitus.

5. Tumors: Rarely, tumors in the head or neck, such as glomus tumors, can cause pulsatile tinnitus due to their proximity to vascular structures.

Symptoms
In addition to the rhythmic sound that coincides with your heartbeat, pulsatile tinnitus may be accompanied by other symptoms, including:
- Ear pain or discomfort
- Hearing loss
- A sensation of fullness in the ear
- Nasal congestion or sinus issues, as you mentioned experiencing nasal obstruction and excessive clear nasal discharge.

Next Steps
Given your symptoms and the duration of your condition, it is essential to pursue further evaluation. Here are some recommended steps:
1. Consult an Ear, Nose, and Throat (ENT) Specialist: An ENT specialist can conduct a thorough examination of your ears, nose, and throat to identify any underlying issues that may be contributing to your symptoms.

2. Imaging Studies: While you have already undergone MRI and hearing tests, it may be beneficial to consider additional imaging studies, such as a CT scan of the head and neck, to evaluate vascular structures and rule out any tumors or vascular malformations.

3. Blood Tests: Given your symptoms of nasal congestion and clear nasal discharge, it may be helpful to check for allergies or infections that could be contributing to your symptoms.

4. Lifestyle Modifications: Reducing the frequency of ear and nose digging can help prevent irritation or injury to the ear canal and nasal passages, which may exacerbate your symptoms.

5. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be valuable for your healthcare provider in determining the underlying cause.

Conclusion
Pulsatile tinnitus can be a complex condition with various potential causes. While it is understandable to be concerned about serious conditions such as nasopharyngeal or oropharyngeal cancer, it is essential to approach this systematically with the help of healthcare professionals. Your symptoms warrant further investigation, and an ENT specialist can guide you through the necessary evaluations and potential treatments. Remember that early diagnosis and intervention can significantly improve outcomes and quality of life.

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...

Understanding Pulsatile Tinnitus: Causes and Concerns

In the past month, I have experienced intermittent pulsating sounds in my right ear, resembling a heartbeat. Each episode lasts for about ten seconds, followed by a minute of normalcy, and then it repeats for approximately ten seconds. Each occurrence lasts for about ten minutes,...

Dr. Ji Zhaoyun reply Otolaryngology
Hello Mr. Wang, The issues you mentioned could possibly be due to: 1) Eustachian tube dysfunction: This is the most common cause and can occur not only during flying, mountain climbing, or diving, but also when forcefully blowing your nose or bending over. Rapid changes in body...

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...