Hearing a rhythmic sound in your head—often described as a whooshing, throbbing, or thumping noise that precisely follows your heart rate—is a symptom known as pulsatile tinnitus. This sensation is distinct from the more common forms of tinnitus, which typically involve a continuous ringing, buzzing, or hissing sound. Because the noise is pulse-synchronous, it originates from a physical process within the body, usually involving blood flow. Pulsatile tinnitus should be investigated by a healthcare professional to determine its underlying cause.
How Internal Sounds Become Audible
The human auditory system is constantly exposed to the sounds generated by the body, but usually, the brain filters these internal noises out. Pulsatile tinnitus occurs when the volume of a sound source, such as blood flow, increases, or the auditory system’s ability to hear that sound becomes amplified. The rhythmic sound is often the result of turbulent blood flow in arteries and veins located near the ear structures, particularly the carotid artery or jugular vein. Blood flow is normally smooth and quiet, but any change in the vessel structure or the speed of the blood can create turbulence, which generates noise. The bony structures of the skull and the middle ear can then transmit these vibrations directly to the inner ear, where they are perceived as sound.
Categorizing the Common Causes
The causes of pulsatile tinnitus are broadly categorized based on whether they involve blood vessels, structural changes in the ear, or systemic factors affecting the body. The majority of cases are traced back to vascular issues, where the sound is the result of blood flow changes near the auditory apparatus.
Vascular and Blood Flow Issues
Conditions that affect the speed or smoothness of blood flow are frequent causes of a pulsing sound in the head. Arteries narrowed by atherosclerosis, or hardening of the arteries, force blood to flow through a restricted space, which creates a louder, more turbulent sound. High blood pressure can also increase the force and speed of blood moving through vessels, making the sounds of circulation more audible.
Sometimes, the veins draining blood from the brain can be structurally abnormal, such as having a narrowing known as venous sinus stenosis. This can lead to increased pressure and turbulent flow in the venous system, causing a whooshing sound that synchronizes with the pulse. Another condition, idiopathic intracranial hypertension (IIH), involves elevated fluid pressure around the brain, which can press on veins and create a pulsing noise.
Less common vascular issues include abnormal connections between arteries and veins, known as arteriovenous malformations or fistulas. These abnormalities divert high-pressure blood flow into low-pressure veins, creating high turbulence. Tumors in the head or neck, such as glomus tumors, can also cause pulsatile tinnitus by pressing on nearby blood vessels and disrupting normal flow.
Conductive and Systemic Factors
Structural changes in the ear can cause an increased awareness of normal internal sounds. Conditions that result in a conductive hearing loss, like fluid behind the eardrum or a perforated eardrum, effectively block external sounds. This muffling makes the body’s internal sounds, including the pulse, seem louder by comparison.
A rare structural issue, superior semicircular canal dehiscence (SSCD), involves a thinning or defect in the bone overlying the inner ear. This bony defect allows internal sounds, such as the heartbeat, eye movements, or chewing, to be transmitted directly to the inner ear.
Certain systemic conditions can increase the overall volume of blood flow in the body. Severe anemia or an overactive thyroid gland (hyperthyroidism) cause the heart to pump blood faster and with greater force, resulting in a generalized increase in audible circulation noise.
When to Seek Medical Guidance
Because pulsatile tinnitus often has an identifiable physical cause, seeking a medical evaluation is recommended. A physician will begin with a detailed history and a physical examination, which includes listening to the neck and skull with a stethoscope. If the doctor can also hear the pulsing noise, it is termed objective pulsatile tinnitus, which helps to narrow the diagnostic focus.
The diagnostic process frequently involves specialized imaging to visualize the blood vessels and surrounding structures. Tests such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT) scans, or Magnetic Resonance Angiography (MRA) are used to look for vascular narrowing, structural defects, or tumors. Certain symptoms are considered “red flags” and warrant prompt attention, including sudden onset of the pulsing sound, changes in hearing, severe headaches, or any visual disturbances.
Treatment and Management Options
The treatment for pulsatile tinnitus is dependent upon the specific underlying cause identified during the medical workup. If the sound is linked to a systemic issue, managing that condition will typically resolve the noise. For instance, medication and lifestyle changes are used to control high blood pressure or hyperthyroidism, which reduces turbulent blood flow.
When the cause is a structural or vascular anomaly, intervention may be necessary to correct the flow disturbance. This can involve placing a stent to open a narrowed vein or artery, or using minimally invasive procedures to repair an abnormal vessel connection.
If the cause is benign and cannot be treated, or if the sound persists after treatment, management focuses on reducing the impact of the noise. Sound therapies, such as using white noise machines or quiet music, can help mask the pulsing sound. Cognitive behavioral therapy can also be used to help individuals manage the stress and anxiety the constant sound may cause.