What is pulsatile tinnitus?
Most tinnitus is a ringing or hissing with no external source. Pulsatile tinnitus is different: it beats, whooshes or thumps in time with your pulse. It occurs when blood flow near the ear becomes loud enough to hear, or when the ear is unusually sensitive to normal vascular sounds. It can be subjective (only you hear it) or, rarely, objective (a doctor can hear it with a stethoscope). See tinnitus treatment and buzzing in ear.
Common, usually harmless causes
- Blocked ear or fluid in the ear: blockage removes background sound so you notice your pulse. See fluid in the ear and earwax blockage.
- Eustachian tube dysfunction and colds.
- High blood pressure and strong pulse.
- Anaemia, overactive thyroid, fever and other states that speed up or increase blood flow.
- Exercise, stress, anxiety and caffeine, which raise heart rate.
- Pregnancy, which increases blood volume.
- Lying on the ear or quiet environments at night.
- Jaw and neck problems sometimes modulate it.
Vascular and structural causes
- Carotid artery narrowing or atherosclerosis and other arterial disease.
- Venous sinus stenosis or sigmoid sinus diverticulum/dehiscence, a common treatable cause in women, sometimes linked to raised intracranial pressure.
- Idiopathic intracranial hypertension (pseudotumour cerebri), with headaches and visual disturbance.
- Arteriovenous malformations or fistulas (abnormal connections between arteries and veins).
- Glomus tumours (paragangliomas), a reddish mass behind the eardrum.
- Fibromuscular dysplasia and aneurysms (rare).
- Paget’s disease of bone and otosclerosis (ear bone disease).
- These are less common, which is why assessment is advised.
How it is evaluated
- History: which ear, constant or intermittent, relation to position, exercise and hearing changes, headaches, vision, medications.
- Examination of ears and eardrums (a red mass behind the drum), listening over the neck and ear, and checking blood pressure and pulse.
- Hearing test (audiogram) and tympanometry.
- Blood tests: blood count, thyroid, sometimes lipids and other tests.
- Imaging: CT or MR angiography and venography, or ultrasound, directed by the findings; one-sided pulsatile tinnitus is usually imaged.
- A referral to ENT, neuro-otology or neuroradiology if needed.
Treatment depends on the cause
- Clear earwax or treat fluid and Eustachian tube problems.
- Control blood pressure, anaemia or thyroid disease.
- Treat vascular problems: stenting or surgery for venous sinus stenosis or dural fistulas, embolisation for AV malformations, surgery for glomus tumours.
- Weight loss and treatment of raised pressure in idiopathic intracranial hypertension.
- Reduce caffeine, nicotine and alcohol if they worsen it.
- Sound enrichment (background music or fan), hearing aids if there is hearing loss, and CBT or mindfulness for distress.
- See hearing aids for tinnitus.
What you can do at home
- Use gentle background sound at night: a fan, white noise or soft music.
- Manage stress, sleep and anxiety; see deep breathing for anxiety.
- Limit caffeine, nicotine and salt.
- Keep fit and manage blood pressure.
- Keep a diary of when it occurs, to help your doctor.
- Avoid inserting objects in the ear.
- Do not ignore it if it is one-sided, persistent or associated with other symptoms.
When to see a doctor
- Any pulsatile tinnitus lasting more than a week or recurring.
- One-sided pulsatile tinnitus.
- Hearing loss, ear fullness or dizziness.
- Headaches, vision changes or tinnitus that changes with posture.
- Pulsatile tinnitus after head or neck injury or neck pain (possible dissection): urgent.
- A new sound with chest pain, breathlessness or fainting.
- Pregnancy with severe headache or visual disturbance.
Three common situations
A woman who hears her heartbeat in one ear at night: examination and imaging for a vascular cause such as venous sinus stenosis may be recommended.
A person with a cold and a blocked ear who notices a pulsing sound: often settles as the blockage clears.
A person with anxiety and palpitations who notices the sound in both ears: stress management and a medical check to exclude other causes.
How to describe it to your doctor
The details you give are the quickest route to the right test. Note which ear (or both), whether the sound beats exactly with your pulse, whether it changes when you press on your neck, turn your head, lie down, bend forward or exercise, whether it stops when you press gently on the neck on the same side, and whether you also have hearing loss, headaches, vision changes or a feeling of ear fullness. Try to record when it is worst, such as at night or when anxious. Bring a list of medicines, since some drugs and supplements can influence blood pressure or the sound.
Outlook: what to expect
The outlook depends on the cause. When pulsatile tinnitus comes from a blocked ear or a temporary state such as a cold, anaemia or stress, it resolves when that cause settles. When a specific vascular cause such as venous sinus stenosis or a dural fistula is found and treated, the sound often disappears completely. When no cause is found, many people still learn to live with it and find it fades into the background with sound enrichment, good sleep and stress reduction. Follow-up is recommended if symptoms change or new ones appear.
Key points to remember
Hearing your heartbeat in your ear is common and often benign, but it can reflect a treatable vascular or structural problem. Have it checked, particularly if it is one-sided, persistent or accompanied by other symptoms, and treat the cause. Our ENT team can assess your ears and hearing.
This guide is for general information and does not replace an examination by your own doctor or ENT specialist.
Questions about heartbeat in the ear
These answers are general information and do not replace an examination or individual medical advice.
Why can I hear my heartbeat in my ear?
Often because of a blocked ear or fluid, high blood pressure, anaemia or stress, though vascular causes exist.
Is pulsatile tinnitus dangerous?
Usually not, but it can reflect a blood vessel problem, so it should be evaluated.
Will it go away?
It often resolves when the cause, such as a blocked ear, is treated.
Does high blood pressure cause it?
It can, by making blood flow more forceful and audible.
When is it urgent?
With sudden hearing loss, severe headache, vision changes, weakness or after a neck or head injury.
What tests are needed?
Ear examination, hearing tests, blood tests and often scans of the blood vessels.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.