What Is Pulsatile Tinnitus?

Medically Reviewed by Jennifer Robinson, MD on September 20, 2023
Written by Shawna Seed
3 min read

If you have a thumping or whooshing sound in one or both ears that seems to follow a steady beat, you may have this rare form of tinnitus. Like regular tinnitus, you hear a constant sound that others don’t. But with the pulsatile form of this condition, the noise comes from inside your body. Your doctor may be able to hear it, too, if they listen with a stethoscope. It’s also called rhythmic, vascular, or pulse-synchronous tinnitus.

You regularly hear a sound with a steady beat that seems in sync with your pulse. You may hear it in only one ear. For many people, the sound can be loud and distracting, sometimes even unbearable.

You might notice other symptoms if you also have high pressure in the fluid around your brain, a condition called idiopathic intracranial hypertension:

If you have idiopathic intracranial hypertension, you may need to lose weight, take medication, or have surgery.

Unlike with regular tinnitus, doctors often can pinpoint a specific health problem behind this type:

Irregular blood vessels. This is a common issue. When blood flows through damaged or kinked vessels in the brain near or around the ear, it can change pressure and noise. A narrow or kinked neck artery (the carotid artery) or vein (the jugular vein) also can cause the sound.

High blood pressure . This can lead to a change in blood flow, and things like stress, alcohol, and caffeine can make the noise more noticeable.

Severe anemia or an overactive thyroid gland. These can make your blood flow quickly and loudly.

Atherosclerosis. This is a hardening of your arteries. As cholesterol and other fats clog your blood vessels, they grow less flexible. That makes blood flowing near your middle and inner ear move with more force, like water through a narrowed streambed. You’ll usually hear it in both ears.

Head and neck tumors. These can press on blood vessels and make noise.

Connection problems between arteries and veins. This condition, called arteriovenous malformation, generally affects only one ear.

You may need to see an ear specialist called an otolaryngologist. You’ll have a hearing test, and the doctor will check your ears. They may also look at your jaw and check your eyes for signs of increased pressure in your brain.

Other tests might include:

  • Brainstem auditory evoked response (BAER), which times electrical waves from your brain in response to clicks in your ear
  • Electrocochleography, which is similar to BAER but uses an electrode placed on or in your eardrum
  • Scans of your brain and blood vessels, such as an MRI or CT scan
  • Blood tests

This kind of tinnitus is often the first clue that you have something else going on that needs to be treated. Your treatment plan will depend on what’s causing your tinnitus. You may need medication or surgery to repair a blood vessel. Once the condition that caused it is treated, the sound should stop.

If you’re still hearing the noise or your doctor can’t find a cause, you can try:

White noise. It can help make the sound less noticeable, especially at bedtime. You can get a special machine that makes it, or see if an air conditioner or fan in your bedroom helps. Some smartphone apps make white noise, too.

Wearable sound generators. These masking devices look like hearing aids. They create a constant, low-level background noise.

Tinnitus retraining. You wear a device that plays music in a frequency that helps you tune out the tinnitus.

If these options don’t help, tell your doctor, who can check further to see what the problem may be.