A rhythmic whooshing or thumping sound in the ear, especially noticeable when lying down, is known as pulsatile tinnitus. This experience is distinct from the more common type of tinnitus, which involves a constant ringing or buzzing sound that does not follow a beat. Unlike generalized tinnitus, the pulsatile form is often traceable to a specific source, typically related to blood flow in the vessels near the ear. While this symptom is frequently benign and temporary, it can sometimes indicate an underlying medical issue that requires professional attention, particularly if the sound is persistent or accompanied by other physical symptoms.
Defining Pulsatile Tinnitus: The Sound Phenomenon
Pulsatile tinnitus is essentially the perception of blood flow noise that is synchronized with the heart’s rhythm. The sound is often described as a whooshing, rushing, or thumping sound that a person can easily time by checking their pulse at the wrist or neck. This is a form of objective tinnitus, meaning a physician can sometimes hear the sound with a stethoscope placed near the patient’s ear or neck.
The mechanism behind this sound involves the close proximity of major blood vessels to the ear’s auditory structures. Both the carotid artery, which supplies blood to the head, and the jugular vein, which drains blood from the head, pass very close to the middle and inner ear. When blood flow is altered in these vessels, the resulting turbulence or change in pressure can be amplified by the ear’s sensitive hearing apparatus.
The sound of normal blood flow is usually too soft to be perceived, but any factor that increases the speed or turbulence of the flow can make it noticeable. When the blood flow is disrupted, it creates a turbulent noise that is transmitted to the cochlea, which registers the sound as though it were external.
Common and Benign Positional Factors
The act of lying down often makes the pulsatile sound more noticeable due to temporary changes in pressure dynamics. When a person reclines, especially on their side, the position can cause slight compression of the internal jugular vein on that side. This compression can slow the return of blood from the head, leading to a temporary increase in blood pressure and turbulence in the veins near the ear.
This temporary change in blood flow creates a slight, audible “venous hum” that is not a sign of serious illness. The quiet environment of a bedroom at night eliminates competing external sounds, which heightens awareness of internal body noises. The reduced ambient noise allows the ear to focus on the subtle, rhythmic sound of blood circulating close to the hearing mechanism.
Minor physical obstructions within the ear can also contribute to the amplification of this internal sound. A simple buildup of excessive earwax, or fluid accumulation in the middle ear from a cold or allergy, can result in a temporary conductive hearing loss. This muffling of external sounds can inadvertently increase the perception of internal noises, including the beat of the heart. These positional or temporary causes are considered benign and often resolve on their own.
Underlying Medical Causes Requiring Attention
Pulsatile tinnitus can be a symptom of a systemic or structural issue that requires medical investigation. Conditions that cause a change in the speed or force of blood flow can make the pulse audible. For example, severe anemia or hyperthyroidism (an overactive thyroid gland) can increase the heart’s output and the velocity of blood flow throughout the body.
Issues affecting the structure of blood vessels are another set of causes. Atherosclerosis, which involves the narrowing of arteries due to fatty deposits, creates uneven vessel walls that generate turbulence as blood rushes past. This turbulent flow in the carotid artery near the ear can translate into the whooshing sound. Aneurysms or Fibromuscular Dysplasia (FMD), which causes abnormal cell growth in artery walls, can similarly create flow disturbances.
Specific anatomical abnormalities close to the ear structure can also be responsible. A glomus tumor, a classic cause of pulsatile tinnitus, is a slow-growing, highly vascular mass that develops near the base of the skull or in the middle ear. An Arteriovenous Malformation (AVM), an abnormal tangle of blood vessels that bypasses the capillaries, causing high-pressure blood to flow rapidly from arteries to veins, is another structural issue. Elevated intracranial pressure, where the fluid surrounding the brain increases pressure on nearby veins, can also cause the rhythmic sound.
When to Seek Professional Evaluation
A professional evaluation is warranted if the pulsatile tinnitus is persistent, lasting more than a few days or weeks, or if it occurs regardless of body position. It is important to see a healthcare provider to rule out serious underlying conditions, especially those related to blood flow and vascular health. Early diagnosis is important because treatment of the root cause can often eliminate the tinnitus completely.
Medical consultation is urgent if the sound is accompanied by other symptoms, such as dizziness, changes in vision, persistent headaches, or sudden hearing loss. The diagnostic process begins with a thorough physical examination and a detailed medical history. If necessary, a doctor may recommend imaging tests, such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans, to visualize the blood vessels and anatomical structures around the ear and head.