A whooshing sound in your ear that pulses with your heartbeat is called pulsatile tinnitus, and unlike the more common ringing-type tinnitus, it usually has a real physical source. Fewer than 10% of people with tinnitus have this pulsatile type. The sound is typically generated by blood flowing turbulently through vessels near your ear, and the fact that it has an identifiable cause means it can often be treated.
What Makes It Different From Ringing
Most tinnitus is a phantom sound created by the hearing system itself, often from damage to the inner ear. Pulsatile tinnitus is fundamentally different. There is an actual sound being produced inside your body, usually by blood moving through arteries or veins near the ear. That’s why it keeps rhythm with your pulse and why, in some cases, a doctor can hear it too by placing a stethoscope against your head or neck.
People describe the sound as whooshing, swooshing, or a rhythmic roar. It can be constant or come and go, and it’s often louder when you’re lying down or after exercise, both situations where blood flow near the head increases.
Blood Vessel Problems Near the Ear
The most common causes involve the blood vessels running through or near the temporal bone, the thick piece of skull that houses your inner ear. Several specific conditions can create turbulent flow loud enough to hear.
A sigmoid sinus diverticulum is now recognized as the most common identifiable cause of venous pulsatile tinnitus. The sigmoid sinus is a large vein channel that drains blood from your brain, running just behind your ear. When a small pouch (diverticulum) bulges out from this channel, or when the thin bone separating it from the middle ear erodes away, blood turbulence in that area becomes audible. Surgery to reconstruct the sinus wall resolves the whooshing completely in about two-thirds of patients and partially in others.
Arteriovenous fistulas, abnormal connections between arteries and veins in the brain’s lining, can produce an unbearably loud roaring sound. These are less common but more urgent because they can affect blood drainage from the brain. Glomus tumors are another possibility: slow-growing, highly vascular masses that develop in the middle ear or at the base of the skull. They cause pulsatile tinnitus in up to 75% of affected patients and often appear as a reddish mass visible behind the eardrum during an ear exam.
Narrowing of the carotid artery from plaque buildup, or a tear in the artery wall (dissection), can also produce turbulent flow you hear as whooshing. These are important to identify because they carry stroke risk.
High Pressure Inside the Skull
Idiopathic intracranial hypertension (IIH) is a condition where the fluid surrounding the brain builds up excessive pressure without an obvious cause like a tumor or infection. It predominantly affects women of childbearing age who are overweight. Pulsatile tinnitus is one of its hallmark symptoms, sometimes the very first one noticed.
Interestingly, the relationship between pressure levels and the whooshing sound isn’t straightforward. Studies have found no consistent correlation between how high the pressure measures on a spinal tap and how severe the tinnitus is. Some patients with only mildly elevated pressure have loud pulsatile tinnitus, while others with very high pressure don’t. Researchers believe structural differences in the sigmoid sinus wall, such as thin spots or small pouches, may determine whether elevated pressure translates into an audible sound. Other symptoms of IIH include headaches (often worse in the morning), brief episodes of vision going dark, and double vision.
Whole-Body Conditions That Speed Up Blood Flow
Not every case of ear whooshing points to a problem in the head. Conditions that make your heart pump harder or your blood flow faster can create enough turbulence to become audible near the ear.
Anemia is one of the most common systemic causes. When your blood has fewer red blood cells, your heart compensates by pumping a larger volume faster, creating turbulence. The resulting sound is sometimes described as a venous hum, audible through a stethoscope. Hyperthyroidism does something similar by revving up your heart rate and increasing blood flow throughout the body. High blood pressure and pregnancy can also create enough circulatory noise to produce whooshing. In these cases, treating the underlying condition (correcting the anemia, managing thyroid levels, controlling blood pressure) typically resolves the sound.
A Simple Test You Can Try at Home
If the whooshing is coming from a vein, gently pressing on the neck on the same side as the sound will often reduce or stop it. This works because compressing the internal jugular vein slows venous flow, eliminating the turbulence that produces the noise. In one study of patients with confirmed sigmoid sinus problems, about 73% experienced this effect with neck compression.
Doctors have used this maneuver since the 1990s to help distinguish venous pulsatile tinnitus from arterial causes. If pressing on your neck quiets the whooshing, it’s a useful clue pointing toward a venous source, and it also predicts a better response to surgical repair. If the sound doesn’t change or gets louder, an arterial cause is more likely. Either way, this observation is worth sharing with your doctor.
How Doctors Find the Cause
Pulsatile tinnitus warrants medical evaluation because, unlike ordinary tinnitus, finding and treating the source is usually possible. The workup typically starts with a physical exam: checking the eardrum for visible masses, listening with a stethoscope over the skull and neck, and testing hearing.
MRI with MR angiography (MRA) is recommended as the first-line imaging test. It’s the most sensitive single tool for detecting the range of potential causes, from abnormal vessel connections to sinus wall defects to tumors. For suspected venous problems like sigmoid sinus diverticula or jugular bulb abnormalities, MR venography (MRV) provides additional detail. If there’s concern about a tear in the carotid artery, CT angiography actually outperforms MRA in sensitivity. And for bony problems, like erosion of the thin bone near the inner ear, CT scanning is superior to MRI.
In practice, the imaging approach depends on what the initial exam suggests. Many patients get an MRI first, with additional CT or specialized sequences added based on what’s found or suspected.
What Treatment Looks Like
Because pulsatile tinnitus has a physical cause, treatment targets that cause directly. This sets it apart from ordinary tinnitus, where management often focuses on coping strategies.
For systemic causes like anemia or thyroid dysfunction, medical treatment of the underlying condition is usually enough. For structural causes near the ear, the approach depends on what’s found. Sigmoid sinus wall reconstruction is a well-established procedure where a surgeon rebuilds the bone and tissue barrier between the sinus and the middle ear. In published surgical series, 28 out of 31 patients in one group and 17 out of 25 in another experienced complete resolution of the whooshing. Arteriovenous fistulas are typically treated through a catheter-based procedure that blocks the abnormal connection. Glomus tumors may be monitored, surgically removed, or treated with radiation depending on their size and location.
For IIH, treatment focuses on lowering intracranial pressure through weight loss, medication that reduces fluid production, or in severe cases, a procedure to drain excess fluid. Stenting of narrowed venous sinuses is another option that has gained traction in recent years.
Why This Symptom Deserves Attention
Harvard Health identifies pulsatile tinnitus of any kind as a symptom that should prompt medical evaluation. Additional features that make the situation more urgent include whooshing in only one ear, associated dizziness or room-spinning sensations, and any sudden changes in hearing. While most causes turn out to be benign structural variants, a small percentage involve conditions like arteriovenous fistulas or arterial disease that carry real health risks if left unaddressed. The good news is that a cause can be identified in the majority of cases, and once found, it’s often treatable.