Pulsatile Tinnitus: When to Seek Medical Advice

Tinnitus issues?

A year ago, when I was diagnosed, I experienced very loud tinnitus in my left ear along with the sound of my heartbeat.
Over time, the tinnitus has improved, but the heartbeat sound has changed to occasionally hearing two thumps when I exercise or climb stairs, or when I am anxious.
I also tend to hear two or three thumps when I am sleep-deprived.
These occurrences are not constant; sometimes I won't hear the heartbeat for twenty days, while other times I might hear it two or three times in a week, especially when I am more fatigued.
Although it happens more frequently in my left ear, it occasionally occurs in my right ear as well.
I have visited a major hospital's outpatient clinic, where the doctor listened to the blood flow in my carotid artery and said it was very normal.
The doctor mentioned that if I were to hear it 24/7, I would need to return for further examination.
They also said that it is common for people to occasionally hear their heartbeat, especially in my case, which might be related to poor blood circulation or dysautonomia from long COVID, causing transient changes in heart rhythm and increased blood flow that can be perceived by the ear.

I would like to ask if it is common for people to occasionally hear their heartbeat? I found online that pulsatile tinnitus typically occurs 24/7, and physiological causes can affect both ears, while vascular pathological causes are more likely to affect one ear.
Should I just continue to observe my symptoms, and only return to the hospital if it becomes a 24/7 issue? Additionally, would taking B vitamins or similar supplements be beneficial? Thank you.

Ayi, 30~39 year old female. Ask Date: 2023/10/28

Dr. Zheng Jueyi reply Otolaryngology

Hello, pulsatile tinnitus typically lasts for 24 hours and can be heard continuously.
If your hearing is currently normal and you only experience occasional tinnitus, you can start with self-observation.
However, if the tinnitus persists or is accompanied by hearing abnormalities, you should return to the hospital for further examination.
Supplementing with B vitamins can be attempted, but there is no research indicating a definitive therapeutic effect on tinnitus.

Reply Date: 2023/10/28

More Info

Pulsatile tinnitus is a type of tinnitus characterized by a rhythmic sound that often coincides with the heartbeat. It can be caused by various factors, including vascular abnormalities, increased blood flow, or changes in the ear structure. Your experience of hearing your heartbeat in your ears, especially during physical exertion or periods of stress, is not uncommon. Many individuals may occasionally perceive their heartbeat in their ears, particularly in quiet environments or when they are more aware of bodily sensations.

In your case, the intermittent nature of your pulsatile tinnitus, where you only hear it during specific activities or states of stress, suggests that it may not be a cause for immediate concern. The fact that your healthcare provider has assessed your carotid blood flow and found it to be normal is reassuring. It indicates that there are no significant vascular issues contributing to your symptoms at this time.

However, it is essential to remain vigilant. If your pulsatile tinnitus becomes persistent, meaning you hear it continuously for 24 hours a day, or if you experience additional symptoms such as hearing loss, dizziness, or changes in vision, it would be prudent to seek further medical evaluation. Persistent pulsatile tinnitus can sometimes indicate underlying conditions that may require treatment, such as vascular malformations or other pathologies.

Regarding your question about the occasional perception of heartbeat sounds in the ears, it is indeed possible for healthy individuals to experience this phenomenon. Factors such as blood flow changes during physical activity, anxiety, or even certain positions can make one more aware of their heartbeat.
As for your inquiry about B vitamins and their potential benefits, while there is no direct evidence linking B vitamins to the alleviation of pulsatile tinnitus, maintaining a balanced diet that includes essential vitamins and minerals is crucial for overall health. B vitamins, particularly B12, play a role in nerve health and function, and deficiencies can lead to neurological symptoms. If you suspect that your diet may be lacking, it could be beneficial to consult with a healthcare provider or a nutritionist to assess your nutritional status and determine if supplementation is appropriate.

In summary, your current experience with pulsatile tinnitus appears to be manageable, especially given the intermittent nature of the symptoms. Continue to monitor your condition, and if there are any changes or concerns, do not hesitate to seek medical advice. Maintaining a healthy lifestyle, including a balanced diet and stress management techniques, can also contribute positively to your overall well-being.

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