Pulsatile tinnitus
Also called: Heartbeat in the ear · Vascular tinnitus
A whooshing or thumping in one ear that keeps time with your pulse. It is usually the sound of blood flowing near the ear. It often has a treatable cause, so get it checked.
How common
Does this happen to you?
How it works
Ordinary tinnitus is a steady ring or hiss made inside the hearing system. Pulsatile tinnitus is different. It is usually 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. Only a thin plate of bone separates each of them from the middle ear6. 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. Causes include a narrowed neck artery and, less often, anaemia or an overactive thyroid3. Pregnancy and hard exercise can bring it on for a while. Some people hear it only when they lie on one side. During an exam, a doctor may press gently on the neck to find out whether a vein or an artery is the source. Do not try this on yourself.
How common it is
Tinnitus of any kind affects 10% to 15% of people1. The pulsatile share comes from clinic studies of tinnitus patients, where it is under 10%5. Pulsatile tinnitus is harder to measure separately, since many surveys do not distinguish it from ordinary ringing tinnitus. Community reports, such as those on r/tinnitus, suggest many mild cases go unmentioned to doctors2, so the true rate may be higher than clinic-based figures show.
Is it a problem?
It can be. Most people with it have a cause that can be treated3. In about 3 in 10 people, no cause is found3. Doctors want to check this kind of tinnitus. Some 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 urgently if it comes with:
- weakness on one side of the body,
- changes in vision,
- headache,
- hearing loss,
- dizziness.
With no other signs, still ask your doctor for an urgent appointment4.
Sources and further material
- Wikipedia Tinnitus
- NCBI Pulsatile tinnitus: imaging and differential diagnosis Dtsch Arztebl Int. 2013;110(26):451-458. Says less than 10% of tinnitus patients have the pulsatile type.
- Wikipedia Tympanic cavity Thin plates of bone separate the middle ear from the jugular fossa and the carotid canal.
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Related oddities
Tinnitus
A ringing, hissing, buzzing, or roaring sound with no source outside your head. Between 10% and 15% of people have it. It is mostly the hearing system filling in for damaged or tired inner-ear cells.
Autophony
Your own voice, breathing, or heartbeat sounds far too loud inside your head. It can mean a tube or a thin patch of bone is letting sound take a shortcut into the ear.
The sound of silence
In a room that absorbs almost all sound, many people hear their heartbeat, their blood, their breath, or a high ringing. True silence is not possible for a living person.
Heart rate control
Slowing or speeding up your own heartbeat on purpose, using breath, attention, or training. Breathing can shift it a little within minutes. A few trained people shift it a lot.