Pulsatile tinnitus

How it works

Ordinary tinnitus is a steady ring or hiss made inside the hearing system. Pulsatile tinnitus is different. It is a real sound, made by blood, and it beats with your heart¹.

Two large blood vessels pass very close to the middle ear. The carotid artery carries blood up to the brain. The jugular vein carries it back down. Both run within millimetres of the bony wall of the ear¹. Smooth flow is silent. Turbulent flow is not. When blood swirls, the vessel wall vibrates, and the ear picks it up as a whoosh, a hum, or a thump.

Anything that makes flow faster or rougher can start it. Common causes are high blood pressure, anaemia, an overactive thyroid, and a narrowed artery¹. Pregnancy and hard exercise can bring it on for a while. Some people hear it only when they lie on one side, or when they press on the neck. Many can make it stop by pressing on the jugular vein, which is a strong clue that a vein is the source.

About 10% to 15% of adults have some form of tinnitus¹. Around 3% to 5% of those have the pulsing kind¹.

Is it a problem?

Usually not. Most cases have a harmless cause or no cause that can be found. But this is the one kind of tinnitus that doctors always want to look at. A small number of cases come from a leaky connection between an artery and a vein, a growth on a blood vessel, or raised pressure inside the skull¹. These are treatable, and they are better found early.

See a doctor if you hear your pulse in one ear for more than a few days. Go sooner if it comes with headache, changes in vision, hearing loss, dizziness, or weakness on one side of the body.