Pulsatile Tinnitus — What Is It?

Pulsatile tinnitus is a type of tinnitus where you hear a rhythmic sound — often described as whooshing, thumping, or beating — that pulses in time with your heartbeat. Unlike regular tinnitus (which is usually a constant ringing or buzzing), pulsatile tinnitus often has an identifiable physical cause.

What causes pulsatile tinnitus?

Pulsatile tinnitus is usually caused by changes in blood flow near the ear. Common causes include:

• Atherosclerosis — narrowed or hardened blood vessels near the ear create turbulent blood flow
• High blood pressure — increased blood pressure can make blood flow more audible
• Anaemia — thinner blood flows faster and may produce audible turbulence
• Glomus tumours — small, benign vascular tumours near the ear
• Abnormal blood vessel formations — arteriovenous malformations or fistulae near the ear
• Intracranial hypertension — raised pressure around the brain, more common in younger women
• Middle ear conditions — fluid or changes in the middle ear can amplify internal sounds

When to see a doctor

Pulsatile tinnitus should always be investigated by a doctor. While many causes are benign and treatable, some require prompt attention. See your GP and request referral to an ENT specialist. Seek urgent care if pulsatile tinnitus is accompanied by sudden hearing loss, severe headache, visual disturbances, or neurological symptoms.

Investigations

Your doctor may arrange:

• Blood tests — checking for anaemia, thyroid problems, and other conditions
• Blood pressure measurement
• Hearing test
• Imaging — MRI or CT scan to visualise blood vessels and structures near the ear
• MRA (magnetic resonance angiography) — specifically to examine blood vessels

Treatment

Treatment depends on the underlying cause. Managing high blood pressure, treating anaemia, or addressing vascular abnormalities can resolve pulsatile tinnitus in many cases. If no specific cause is found, management strategies similar to those used for regular tinnitus may help.