Pulsatile Tinnitus and Nasal Congestion: the Connection

Pulsatile tinnitus and nasal congestion?

Hello, Doctor! Last winter, I noticed that I sometimes hear a heartbeat sound in my left ear, but it only occurs when I lie on my left side while sleeping.
It disappears when I lie on my back for a while or on my right side.
It does not occur when I am standing or sitting at work.
Here are my observations; I am not sure if they are related to tinnitus! I consulted a physician who suggested it might be a case of exercise-induced nasal congestion, which seems to be related to autonomic nervous system dysregulation.
When I sleep on my left or right side, the nostril facing down becomes congested, while the other nostril remains completely clear.
I do not have any symptoms of nasal allergies or sinusitis, but I do experience clear nasal discharge when eating hot food! When the tinnitus occurs in my left ear, the left nostril is blocked when I lie on my left side, and when I am lying on my back or on my right side, the left nostril is clear, and there is no tinnitus.
Pressing on the carotid artery does not change the volume of the sound, so it seems unrelated! Therefore, I would like to ask the doctor if it is possible that the swelling of the left nasal turbinate is compressing the Eustachian tube, causing me to hear the heartbeat sound? Does hearing a pulse in the ear indicate that there is a pathological change in the body? Is this something that can happen to normal individuals as well? Can exercise-induced nasal congestion be treated with minimally invasive surgery on the inferior turbinate, such as radiofrequency ablation? I would appreciate your advice, thank you!

Zhao Xin, 30~39 year old female. Ask Date: 2013/03/01

Dr. Zheng Jueyi reply Otolaryngology

Dear Zhao Xin,
Hello.
Hearing a heartbeat in your ear while lying on your left side may be related to vascular issues.
It is possible that the veins or arteries in the middle ear are positioned more superficially, causing pulsatile tinnitus due to changes in body posture.
If a specialist examines you and finds no significant vascular malformations in the middle ear cavity, it is likely a normal variation.
As for the chance of the inferior turbinate causing congestion and compressing the Eustachian tube, this is less likely due to anatomical considerations.
For nasal congestion caused by exercise-induced rhinitis, medication can be used initially.
If the results are unsatisfactory, minimally invasive surgery on the inferior turbinate should help alleviate the symptoms of nasal congestion.
Wishing you peace and health.
Sincerely,
Dr.
Zheng Jueyi
Director, Department of Otolaryngology
Taoyuan General Hospital, Ministry of Health and Welfare

Reply Date: 2013/03/01

More Info

Pulsatile tinnitus, characterized by hearing a rhythmic sound that often coincides with the heartbeat, can indeed be influenced by nasal congestion and other related conditions. In your case, the observation that the tinnitus occurs primarily when lying on your left side suggests a potential connection between the position of your head, the state of your nasal passages, and the auditory sensations you are experiencing.

When you lie on your left side, the left nasal passage becomes congested, which could lead to increased pressure in the area surrounding the ear and eustachian tube. The eustachian tube connects the middle ear to the nasopharynx and helps equalize pressure in the ear. If the nasal congestion is significant, it may affect the eustachian tube's ability to function properly, leading to a sensation of fullness or pressure in the ear, which can manifest as pulsatile tinnitus.

The connection between nasal congestion and tinnitus is not uncommon. Conditions such as allergic rhinitis or vasomotor rhinitis can lead to nasal swelling and congestion, which may, in turn, affect the eustachian tube and contribute to auditory symptoms. The fact that you experience clear nasal discharge when consuming hot foods suggests that your nasal passages are reactive, which aligns with the symptoms of rhinitis.

Regarding your concern about whether the pulsatile tinnitus indicates a serious underlying condition, it is important to note that while pulsatile tinnitus can sometimes be associated with vascular abnormalities or other medical issues, it is also common in individuals without any significant health problems. The fact that pressing on the carotid artery does not change the sound is a reassuring sign, as it suggests that the tinnitus is likely not related to vascular issues.

As for the treatment options for your nasal congestion, minimally invasive procedures such as radiofrequency ablation of the inferior turbinates can be effective in reducing nasal obstruction caused by turbinate hypertrophy. This procedure aims to shrink the turbinates, which can improve airflow and potentially alleviate associated symptoms, including those related to tinnitus.

In summary, your symptoms of pulsatile tinnitus and nasal congestion are likely interconnected. The congestion in your left nasal passage when lying on that side may be contributing to the auditory sensations you are experiencing. It would be advisable to consult with an ear, nose, and throat (ENT) specialist who can evaluate your nasal passages and eustachian tube function more thoroughly. They may recommend further diagnostic tests or treatments tailored to your specific condition, including the possibility of surgical interventions if conservative measures do not provide relief.

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