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Pulsatile tinnitus is a form of tinnitus in which the perceived sound is rhythmic and often in sync with the patient’s heartbeat. Unlike typical tinnitus, which is usually caused by auditory system damage, pulsatile tinnitus often arises from vascular causes, such as turbulent blood flow in nearby vessels, high blood pressure, vascular tumors, or abnormalities like arteriovenous malformations. It can also result from increased intracranial pressure or conditions affecting the temporal bone.
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Patients typically describe a whooshing, thumping, or rhythmic sound in one or both ears. The sound may be continuous or intermittent and often becomes more noticeable in quiet environments or when lying down. In some cases, pressing on the neck or turning the head can alter the sound, indicating a vascular origin.
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Diagnosis involves a thorough history, otoscopic examination, and auscultation around the ear and neck to detect vascular bruits. Audiometric testing helps assess hearing function, while imaging studies such as MRI, MR angiography, CT angiography, or Doppler ultrasound are crucial to identify vascular abnormalities or masses.
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Treatment targets the underlying cause. Managing hypertension, correcting vascular malformations, or removing vascular tumors can resolve the symptom. In cases where no cause is found, sound therapy, cognitive-behavioral therapy, and tinnitus retraining therapy can help reduce the distress associated with pulsatile tinnitus.
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Because pulsatile tinnitus may signal serious vascular or neurological conditions, prompt evaluation is essential. Identifying and treating the underlying disorder not only alleviates symptoms but also prevents potential complications such as stroke or intracranial hemorrhage.
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