Pulsatile Tinnitus: Causes and Next Steps for Diagnosis

Q: Pulsatile Tinnitus: Causes and Next Steps for Diagnosis

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) Sudden sensorineural hearing loss. <br>3) O

Unilateral tinnitus with a sensation of fullness and then a pulsatile sound?

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 pinch my nose and blow with my mouth closed, then asked which side felt clearer.
After trying, I only heard a popping sound in my right ear, while my left ear did not respond.
The doctor diagnosed me with Eustachian tube dysfunction and prescribed medication.
However, as I thought more about it at home, I became increasingly anxious.

On Tuesday of this week, I went to a larger hospital's ENT department.
The doctor conducted a tuning fork test and used a nasal endoscope, and all examinations were normal.
There were no abnormalities in the Eustachian tube.
To rule out sudden sensorineural hearing loss, I also underwent pure tone audiometry and tympanometry, both of which returned normal results.
However, my left ear still has sound, which has changed from a continuous ringing to a pulsating sound that matches my heartbeat.
This has made me quite anxious.

Additionally, I have noticed another issue: when I bite down on something, I hear a faint high-frequency sound in my left ear.
Also, when I press on the bone behind my left ear (I’m not sure of the medical term), I hear a similar high-frequency sound.
I confirmed that there is no sound when I perform the same actions on my right ear, and the sound is almost identical to the tinnitus I am experiencing.

Should I return to the otolaryngologist for further evaluation, or should I consult a neurologist? Thank you for taking the time to respond.

HTS, 30~39 year old female. Ask Date: 2022/10/21

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 media: a) Acute otitis media: Often occurs alongside upper respiratory infections (like colds) and sinusitis, and in severe cases, the ear may discharge fluid or pus.
b) Chronic otitis media with acute exacerbation: This usually occurs when there is a pre-existing perforation in the eardrum, which can become inflamed due to unclean water or improper ear cleaning.
All of the above conditions can be appropriately treated with medication after consulting a healthcare provider.
If you have already undergone pure tone audiometry (which requires headphones in a soundproof room, where sounds prompt you to press a button, rather than just using a tuning fork), and it has been confirmed that you do not have sudden sensorineural hearing loss, then medication may suffice.
However, if you have not had a pure tone audiometry test, it is recommended to visit a hospital for evaluation to rule out sudden hearing loss, as there is a critical treatment window for this condition, and early intervention yields better outcomes.
Wishing you safety and good health.

Reply Date: 2022/10/21

More Info

Pulsatile tinnitus is a type of tinnitus characterized by hearing a rhythmic sound that often coincides with the heartbeat. This condition can be particularly concerning, as it may indicate underlying vascular issues or other medical conditions. Given your symptoms and the evaluations you've undergone, let's break down the potential causes and the next steps for diagnosis.

Causes of Pulsatile Tinnitus
1. Vascular Issues: Pulsatile tinnitus is often linked to blood flow changes in the vessels near the ear. Conditions such as arteriovenous malformations (AVMs), vascular tumors, or increased blood flow due to conditions like anemia or hyperthyroidism can lead to this type of tinnitus.

2. Middle Ear Problems: Issues such as eustachian tube dysfunction, which you mentioned, can cause a sensation of fullness and may contribute to tinnitus. The eustachian tube helps equalize pressure in the middle ear, and if it is blocked, it can lead to abnormal sounds.

3. Muscle Spasms: Sometimes, spasms in the muscles of the middle ear or even the jaw can produce sounds that are perceived as pulsatile tinnitus. This could explain the high-frequency sounds you hear when biting down or pressing on the area behind your ear.

4. Neurological Conditions: Although less common, certain neurological conditions can also manifest as pulsatile tinnitus. This includes conditions affecting the auditory nerve or brainstem.

Next Steps for Diagnosis
Given that you've already seen an ENT specialist and undergone several tests, including a tuning fork test and tympanometry, it might be beneficial to consider the following steps:
1. Follow-Up with ENT: Since your symptoms have changed and you are still experiencing pulsatile tinnitus, it would be wise to return to your ENT specialist. They may want to conduct further imaging studies, such as an MRI or CT scan, to rule out any vascular abnormalities or structural issues in the ear and surrounding areas.

2. Consult a Neurologist: If your ENT evaluation does not reveal any significant findings, consulting a neurologist may be the next step. They can assess for any neurological causes of your symptoms, especially if you experience any additional symptoms like headaches, dizziness, or changes in vision.

3. Audiological Evaluation: A comprehensive audiological evaluation may also be beneficial. This can include more detailed hearing tests to assess any subtle changes in hearing that may correlate with your tinnitus.

4. Consider Other Specialists: Depending on the findings, you might also consider seeing a dentist or orthodontist if there is a suspicion that your jaw alignment or dental issues could be contributing to your symptoms.

Conclusion
Pulsatile tinnitus can be distressing, especially when accompanied by other symptoms. While your initial evaluations have not indicated any serious issues, the persistence and change in your symptoms warrant further investigation. It is essential to communicate your ongoing concerns with your healthcare providers, as they can guide you through the appropriate diagnostic process. Remember, early diagnosis and management can significantly improve outcomes, so don’t hesitate to seek further evaluations.

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, Symptoms, and Next Steps

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 na...

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 w...

Understanding Pulsatile Tinnitus and Sudden Hearing Loss: Causes and Treatments

Hello Doctor, one week ago I experienced tinnitus and a feeling of fullness in my left ear in the morning. The tinnitus is pulsatile (like E E E sounds) and is accompanied by the sensation of ear fullness. Three days later, I went to the county hospital for an examination, and th...

Dr. Zheng Jueyi reply Otolaryngology
Hello, it is also possible that it could be inner ear edema or Meniere's disease. If there is no significant improvement with medication, it is recommended to continue follow-up visits for examination and treatment. Wishing you safety and health. Sincerely, Dr. Cheng Jue-Yi,...