What is Pulsatile Tinnitus

Pulsatile tinnitus is a rare form of tinnitus that’s characterised by a whooshing, throbbing or rhythmic thumping noise, which can be present in either one or both of the ears. It’s also referred to as vascular, rhythmic or pulse-synchronous tinnitus.

Quite often, there is an underlying cause for developing pulsatile tinnitus, unlike regular tinnitus. Usually, once this has been identified and addressed, the unpleasant beating sound in the ear or ears tends to go away, although in some cases it may go away of its own accord.

Here’s everything you need to know about this condition.


What differentiates pulsatile tinnitus from regular tinnitus is that there is a beating or rhythmic sound, which is often described as like a heartbeat, or in tune with a person’s heartbeat. This sound may be constant, or it could come and go.

Sufferers often find that the beating noise in their ears matches the speed of their heartbeat, so that the noise in the ear increases when their heart rate goes up, and vice versa.

Hearing a heartbeat-like sound in the ears can be normal after exercise, but with pulsatile tinnitus, the noise can be heard even without doing any physical activities.

Symptoms can seem worse during the quiet of the night, and sufferers often report difficulty sleeping because of it, as well as finding it hard to concentrate during the day.

If this condition is a result of an underlying problem, then other symptoms may also be present.

What causes pulsatile tinnitus?

Because some of the causes of pulsatile tinnitus can relate to serious underlying health conditions, it’s always worth consulting a professional if you suspect you have this problem.

Chances are the problem is benign and could go away by itself. For instance, having blocked sinuses can cause fluid to accumulate near the back of the eardrum, which can create a pulsing sound in the ears. Once the sinuses have cleared and improved, such as after a cold, the ear noise should dissipate.

To understand why pulsatile tinnitus has occurred, the ears will be examined and other tests may be carried out. The doctor may also be able to hear the rhythmic sounds upon examination.

Here are some of the common underlying causes of pulsatile tinnitus.

High blood pressure

If your blood pressure is high, blood will flow more vigorously through the carotid artery, located on the sides of the neck. This creates a pulsating noise, which can be heard through the ears. High intakes of caffeine or alcohol, as well as elevated stress, can exacerbate the pulsing sounds.

Blood vessel problems

Kinked or damaged blood vessels located near the ear can alter the sound and pressure of blood as it flows through, creating the whooshing and beating noises characteristic of this condition.


This is the hardening and narrowing of the arteries, and when this happens near the ears, blood has a harder job trying to flow through. This makes blood move with more force, creating a thumping sound in the ears.

Overactive thyroid gland or anaemia

If you suffer from an overactive thyroid gland, or hyperthyroidism, or severe anaemia, you are more prone to suffering from pulsatile tinnitus, as these conditions can encourage blood to flow past your ears faster and louder.

Head or neck tumours

Tumours of the head or neck can press on the blood vessels around the ears causing the noise associated with pulsatile tinnitus.

Ear abnormalities

Where the bone that lies over the arteries and veins near the ear becomes thin or is missing, this can result in pulsatile tinnitus. Abnormalities around the sinus wall can also cause pulsatile tinnitus, because of changes to blood flow.

Increased fluid pressure around the brain

Increased fluid pressure around the brain, medically known as idiopathic intracranial hypertension, may be an underlying cause of pulsatile tinnitus. If you have this condition, you may also experience headaches and pain behind the eye.

Diagnosing pulsatile tinnitus

As well as examining the ears, a clinician may perform several tests and examinations to get an understanding of why you may be experiencing pulsatile tinnitus.

Tests might include measuring blood pressure, listening to your heartbeat, carrying out blood tests to check anaemia or thyroid levels, as well as a hearing test.

Your jaw may also be examined, as well as the eyes to check for any increased pressure present in the brain.

A scan of the brain, blood vessels and bones may also be carried out.

Even after a complete examination has been performed, in some cases, it might still not be clear why you are experiencing this form of tinnitus. However, ruling out serious underlying illnesses is important.


Treatment for pulsatile tinnitus depends on the underlying cause diagnosed. For example, medications may be prescribed for thyroid problems, anaemia or high blood pressure.

Lifestyle changes may also be advised if high blood pressure is a result of factors such as smoking, poor diet or lack of exercise.

In some cases, surgery may be required if a patient is diagnosed with a head or neck tumour, or a blood vessel disorder.

Usually, once the underlying cause has been correctly treated, pulsatile tinnitus will go away.

Yet, for some sufferers, where a cause can’t be ascertained, the condition may need to be managed in other ways. Clinicians may recommend the use of sound therapy, wearable devices that emit a background noise or white noise to block out the unpleasant beating in the ears.

Cognitive behavioural therapy (CBT) may be recommended to help you to come to terms with the condition, and try to think about how you view it in a different, more positive way. Relaxation techniques including yoga and meditation may help to take your mind off the problem and reduce any associated stress while helping to improve the quality of your sleep.

Tinnitus retraining techniques may also prove useful, such as wearing a device that plays music at a frequency that can cancel out any nuisance tinnitus noise.

It might be worth trying different options to see which is the most suitable for you, as well as seeking advice from a tinnitus specialist.

If pulsatile tinnitus, or regular tinnitus, are affecting you, contact the Tinnitus Management experts at London Hearing for information and support.