Hearing a thumping, whooshing, or rhythmic sound inside the ear is a physical symptom distinct from common ringing in the ears. This sensation directly correlates with the body’s circulatory function. The sound is typically synchronous with the heart, essentially making the pulse audible within the ear canal. Understanding this rhythmic thumping is the first step toward addressing the underlying cause, which can range from temporary changes to more complex structural issues.
Defining the Sound: Pulsatile Tinnitus
The thumping sound is formally known as pulsatile tinnitus, a specific type of auditory perception synchronous with the patient’s heartbeat. This synchronization separates it from non-pulsatile tinnitus, which is typically a continuous sound like ringing or buzzing. Pulsatile tinnitus accounts for only 5% to 10% of all reported tinnitus cases.
The sound originates from blood flow through vessels near the ear structure. It is often described as an “objective” sound because it can sometimes be heard by a doctor using a stethoscope placed near the patient’s ear or neck. This external detectability indicates a physical source, usually a change in blood flow or surrounding anatomy, where the ear amplifies the rush of blood.
Common Causes Related to Temporary Changes
Pulsatile tinnitus is often linked to temporary physiological changes that increase blood flow intensity or amplify existing sounds. A hyperdynamic circulatory state, where blood flow is faster or more forceful, makes the whooshing sound more apparent. This state can result from temporary spikes in blood pressure due to intense exercise, high stress, or consuming stimulants like caffeine. Chronic high blood pressure (hypertension) also increases the force of blood against vessel walls, contributing to a louder sound.
Anemia is a related cause, as the lack of healthy red blood cells forces the heart to compensate by increasing the speed and turbulence of blood flow. This results in a more audible sound near the ear. Conductive hearing loss is another factor, making a person more aware of internal body sounds. When the outer or middle ear is blocked, external sounds are muffled, amplifying internal processes like blood flow. Conditions such as earwax impaction, fluid buildup from a cold, or a middle ear infection can temporarily induce pulsatile tinnitus by reducing outside noise perception.
Underlying Vascular and Structural Conditions
Pulsatile tinnitus can signal chronic vascular or anatomical conditions. A common structural cause is atherosclerosis (hardening of the arteries) in vessels near the ear, such as the carotid artery. Plaque buildup creates an irregular inner vessel surface, causing blood flow to become turbulent and perceived as a loud, rhythmic whooshing.
Narrowing (stenosis) of the large veins draining blood from the brain, like the transverse and sigmoid sinuses, is another significant cause. This disruption creates turbulence transmitted to nearby ear structures. Over half of venous-related cases are associated with Idiopathic Intracranial Hypertension (IIH). IIH involves elevated cerebrospinal fluid pressure, which can indirectly compress these venous sinuses and generate the pulse sound.
The sound may also be generated by vascular malformations, such as dural arteriovenous fistulas (dAVFs), which are abnormal, high-pressure connections between arteries and veins. Rarer, non-vascular causes include slow-growing, highly vascularized tumors, like glomus tumors, developing in the middle ear or near the jugular bulb. These tumors can increase local blood flow or physically impinge upon nearby blood vessels, causing the thumping sensation.
Seeking Diagnosis and Treatment
A persistent thumping warrants consultation with a healthcare provider, such as an otolaryngologist (ENT specialist). During the physical examination, the doctor uses a stethoscope (auscultation) over the neck, skull, and ear. If the doctor can hear the rhythmic sound, it objectively confirms a vascular source.
The diagnostic process involves targeted imaging studies to visualize blood vessels and surrounding structures. Magnetic Resonance Angiography (MRA) and Computed Tomography Angiography (CTA) are frequently used to create detailed images of the arteries and veins. These help identify blockages, stenoses, or malformations. Blood work may also be ordered to check for systemic causes, such as anemia or thyroid dysfunction, which influence blood flow dynamics.
Treatment depends entirely on the specific cause identified. Simple issues like earwax impaction are resolved by removal. For cases linked to high blood pressure or hyperthyroidism, managing the underlying condition through medication and lifestyle adjustments often resolves the tinnitus. Complex causes, such as significant vascular stenosis or malformations, may require specialized procedures, like placing a stent to widen a narrowed vein or using embolization to close an abnormal vessel connection.