The sensation of your eardrum seemingly “beating” or throbbing is a common experience that can cause alarm. This rhythmic sound perception is an internal noise, distinct from the typical ringing or buzzing associated with general ear issues. The experience is usually related to a sound generated within the body and transmitted to the ear structures, which is why it often feels like a pulse. This internal sound directs attention toward underlying bodily functions, particularly the vascular system, and warrants investigation to determine its source.
Understanding Pulsatile Tinnitus
The perception of a rhythmic sound synchronized with your heartbeat is formally known as pulsatile tinnitus. This condition is a specific subtype of tinnitus, the general term for hearing noises when no external sound source is present. Unlike standard tinnitus, which is usually a subjective experience, pulsatile tinnitus is frequently objective. This means a physician may be able to detect the sound using a stethoscope placed near the ear or neck. The throbbing or whooshing noise represents an awareness of blood flow or other mechanical activities near the auditory system. Because this audible internal noise originates from a physical source, the sound often fluctuates with changes in heart rate, such as during exercise or stress.
Causes Related to Blood Flow
The most frequent source of pulsatile tinnitus is a change in blood flow through the large blood vessels positioned near the ear. These vessels, including the carotid artery and jugular vein, carry a significant volume of blood. Any alteration to that flow can be perceived as an audible sound. When blood flow is turbulent rather than smooth, the resulting noise is amplified and transmitted through the bone and tissue to the middle ear.
Atherosclerosis, the hardening and narrowing of arteries due to plaque buildup, is one such vascular cause. As artery walls lose elasticity and the passageway constricts, blood is forced through a smaller opening, creating an audible whooshing sound with each pulse. Elevated blood pressure (hypertension) can intensify this effect by increasing the force and speed of blood moving through the vessels, making the sounds of circulation louder.
Structural anomalies in the veins near the ear can also cause the rhythmic noise. For instance, a high-riding jugular bulb, where the large vein sits unusually close to the middle ear, can make the blood flow more perceptible. Venous sinus stenosis involves a narrowing of the large veins in the brain that drain blood, which creates turbulence and a louder sound as blood passes the constriction. Additionally, a general hyperdynamic state, such as that caused by severe anemia or an overactive thyroid, increases the volume and velocity of blood flow throughout the body, making the pulse sound more apparent.
Causes Related to Muscle and Structure
Not all rhythmic ear noises are linked to the vascular system; some arise from mechanical or structural issues. One common non-vascular source is middle ear myoclonus, which involves involuntary spasms of the tiny muscles within the middle ear space. These muscles, including the tensor tympani and the stapedius, normally contract to protect the inner ear from loud sounds.
When these muscles twitch or spasm, the movement causes a rapid clicking or fluttering sound that is not synchronized with the heartbeat. This mechanical noise is transmitted directly to the eardrum and may be loud enough to be categorized as objective tinnitus. Another structural condition is Eustachian Tube Dysfunction. Here, the tube connecting the middle ear to the back of the nose does not open or close correctly, causing pressure changes that can result in popping or clicking noises.
More rarely, a vascular tumor, such as a paraganglioma, may be located close to the ear structures. Although usually benign, these tumors are highly vascular and can press on surrounding blood vessels, creating turbulent blood flow and mechanical pressure. These mechanical and muscular causes require a separate diagnostic approach from vascular issues, as treatment involves addressing the physical source of the sound rather than the fluid dynamics of circulation.
When to Consult a Professional
If you are experiencing persistent pulsatile tinnitus, seek a medical evaluation to determine the underlying cause. While many causes are treatable or benign, the symptom can be the first sign of a more serious condition, particularly one involving blood flow or pressure. A thorough examination typically begins with a physical assessment, where a doctor may listen to the neck and area around the ear for an audible sound, known as a bruit.
The diagnostic process often involves specialized imaging to visualize the blood vessels and surrounding anatomy. Identifying the precise cause is the first step, and treatment is then targeted at managing the underlying condition, which may involve medication to control blood pressure or a procedure to address a specific vascular anomaly. Common imaging techniques include:
- Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) to evaluate arteries and veins in the head and neck for potential narrowing or anomalies.
- Computed Tomography (CT) scans to look for structural issues in the bone of the middle ear, such as a high jugular bulb or signs of a tumor.