Hearing a rhythmic whooshing, thumping, or pulse in your ear is known as pulsatile tinnitus. This sensation is fundamentally different from common tinnitus, which typically presents as a constant ringing, buzzing, or hissing sound unrelated to the body’s rhythm. Pulsatile tinnitus is characterized by being synchronous with your heartbeat, meaning the sound speeds up and slows down as your pulse changes. Because it almost always suggests a physical source related to blood flow or sound transmission near the ear structure, experiencing a pulse in the ear always warrants a medical evaluation.
Temporary and Benign Causes of Pulsatile Tinnitus
The sensation of hearing one’s pulse can often be traced back to non-pathological factors that simply amplify internal body sounds. One of the most frequent reasons is a quiet environment, especially at night when external noises are absent. This absence of masking sound allows the normal, quiet noises of blood flow to become noticeable. Heightened stress or anxiety can further intensify this perception by increasing the heart rate and blood flow velocity, making the internal pulse louder.
Conductive hearing loss, where sound waves struggle to pass through the outer or middle ear, is another common amplifying factor. When the ear canal is blocked by earwax buildup, fluid from a middle ear infection, or a perforated eardrum, external noise is muffled. This reduction in external sound causes a temporary increase in the perception of internal sounds, including the flow of blood through nearby vessels.
Temporary physiological changes that increase the speed of blood flow can also trigger pulsatile tinnitus. Strenuous exercise, a high fever, or the increased cardiac output associated with pregnancy can lead to a temporary surge in blood circulation. Similarly, conditions like severe anemia or hyperthyroidism cause blood to flow faster and more turbulently. This systemic increase in flow creates a louder sound easily transmitted to the inner ear structures.
Underlying Vascular and Structural Issues
When pulsatile tinnitus is persistent, it often indicates a change in the physical structure or flow dynamics of the blood vessels near the ear. One common cause is atherosclerosis, or the hardening of arteries, which creates an irregular vessel lining. Blood is forced to flow past plaque deposits in the carotid arteries, generating a turbulent, higher-pitched whooshing sound transmitted through the skull base to the cochlea.
Benign tumors, such as glomus tumors, are highly vascular masses that grow near the middle ear or jugular bulb. Their proximity to the hearing apparatus generates a loud, rhythmic sound from the massive blood flow within the tumor itself. The tumor can also physically press on the tiny bones of hearing, distorting their movement and mechanically transmitting the pulse sound directly.
Structural abnormalities in the skull can also contribute, particularly high-riding jugular bulbs or sigmoid sinus wall dehiscence. The jugular bulb is a large vein that sits close to the inner ear. If it is positioned abnormally high, or if the bone separating it from the ear is missing or thinned (dehiscence), the normal venous blood flow becomes audible. This often results in a lower-pitched, rumbly sound that can sometimes be silenced by gently pressing the vein in the neck.
A more complex cause is Idiopathic Intracranial Hypertension (IIH), a condition primarily affecting overweight young women that increases pressure inside the skull. This elevated pressure often causes a narrowing (stenosis) of the large veins in the head, specifically the transverse sinuses. The increased pressure and the resulting narrowing both contribute to turbulent, noisy blood flow in the venous system, which is then perceived as pulsatile tinnitus.
Medical Assessment and Next Steps
Because pulsatile tinnitus can signal a condition requiring treatment, seeking professional medical evaluation is necessary. A detailed history of the sound, including its pitch, location, and whether it can be stopped by pressing on the neck, helps the physician narrow the potential causes. The initial physical examination includes auscultation, where the doctor listens over the ear, neck, and skull with a stethoscope to determine if the sound is objective.
An audiological exam is frequently performed to check for any underlying conductive hearing loss that might be amplifying the sound. If a vascular or structural cause is suspected, imaging tests are ordered to visualize the blood vessels and surrounding bone. Common imaging methods include Magnetic Resonance Angiography (MRA) or Computed Tomography Angiography (CTA), which provide detailed pictures of the arteries and veins in the head and neck.
Urgency signals that warrant immediate medical attention include pulsatile tinnitus accompanied by symptoms such as sudden dizziness, changes in vision, or severe, persistent headaches. Once an underlying cause is identified, treatment focuses on resolving that issue, which may involve medication to manage blood pressure or thyroid function. In cases of structural or localized vascular problems, specialized procedures like stenting to correct vessel narrowing or surgery to remove a highly vascular tumor may be necessary.