Pulsatile tinnitus is a rhythmical noise that beats in time with your pulse. There may be single or multiple rhythmic beats that can be heard as a low pitched thumping or booming sound, or as a higher pitched clicking noise.

While Pulsatile tinnitus is not a common form of tinnitus, it has some well-known causes including hypertension, heart murmur, glomus (globe-shaped) tumor, Eustachian tube disorder, or an abnormality of a vein or artery. More often than not, Pulsatile tinnitus can be treated effectively.

Pulsatile tinnitus is caused by a change of blood flow in the large arteries and veins in the neck, base of the skull, or the smaller blood vessels inside the ear.

Blood flow can be affected by a variety of factors including:

Generalized increased blood flow throughout the body which occurs during strenuous exercise or can be caused by severe anemia.

Localized increased blood flow can occur when a blood vessel is narrower than it should be. This results in the need for adjoining blood vessels to carry extra blood. The additional flow generates noise and can result in Pulsatile tinnitus.

Turbulent blood flow occurs when the inside of a blood vessel becomes constricted (hardening of the arteries) and the blood flow becomes erratic rather than smooth.

When Pulsatile tinnitus is suspected, additional tests may be required to study the blood vessels and check the pressure inside the head. Patients with Pulsatile tinnitus will generally undergo some form of medical imaging such as Ultrasound, CT scanning, Magnetic resonance scanning (MRI), Magnetic resonance angiography (MRA), or Angiography.

Potential causes of Pulsatile tinnitus include:

• Arteriovenous malformations (AVMs) – abnormal group of arteries and veins that occur within the cranial cavity near the auditory nerve.
• Carotid artery-cavernous sinus fistula – abnormal connection between a large artery and venous pool within the cranial cavity; usually the result of severe head trauma.
• Chronic inflammation and/or infection of the middle ear. Chronic inflammation is almost always accompanied by increased blood flow to the inflamed tissue. Because this tissue is in the ear, some people are able to hear the increased blood flow.
• Middle ear fluid. The middle ear is normally an air-filled space. If infection or inflammation occurs, or there is Eustachian tube dysfunction, fluid will accumulate behind the middle ear, resulting in Pulsatile tinnitus.
• Vascular tumors in the middle ear – commonly referred to as glomus (globe-shaped) tumors or paragangliomas. Surgery is required for correction of this problem.
• Pulsatile tinnitus will also occurs when the is a narrowing or a partial blockage of these arteries from an atheroma which is a fatty deposit in inner lining of an artery, which can obstruct blood flow and is caused by high levels of cholesterol in the body.

Can pulsatile tinnitus be treated?

Treatment for Pulsatile tinnitus is related to its specific cause. For example, high blood pressure can be treated with medication and blocked or narrowed arteries can be surgically repaired.

Lowering the cholesterol levels in the blood will also help in lowering the levels of pulsatile tinnitus.

Treatment of pulsatile tinnitus generally involves a multi-disciplinary approach and includes a variety of symptom management methods. The majority of patients with Pulsatile tinnitus are treated with standard methods of tinnitus treatments including drug therapy, alternative treatments, biofeedback and sound and/or relaxation therapy.