Pulsatile Tinnitus

What is Pulsatile Tinnitus?

Pulsatile tinnitus is a condition characterized by rhythmic whooshing or thumping sounds within the ear that are usually in synch with your heartbeat or pulse, although not always. Pulsatile tinnitus is a fairly rare condition that is brought on by the constricted blood flow in and around the ears.

In most cases pulsatile tinnitus will be in one ear, but you may experience it in both. Health-wise, pulsatile tinnitus usually isn’t anything to worry about, but the condition may be a sign of an underlying health complication, so it would be wise to book an appointment with your doctor to find out what might be causing your symptoms.

Pulsatile tinnitus is mostly reported as an annoying rather than severe symptom, however some experience it to a debilitating degree.

Pulsatile tinnitus rarely goes away by itself and some find it difficult to put up with. The sounds can become so intense and frequent as to become incapacitating, they may interfere with work, cause difficulty sleeping or concentrating, increase stress, and create feelings of depression or anxiety.

Fortunately, pulsatile tinnitus can often be successfully treated once its underlying cause is identified.

Possible causes of Pulsatile Tinnitus

Changes to Blood Flow

Blood flow patterns can be changed for a number of reasons, include high blood pressure, plaque build up in arteries or blood vessel disorders or abnormalities. It is usually when these problems affect blood vessels around the head or ear that you may experience pulsatile tinnitus.

Ear Abnormalities

Within the ear, certain structures such as the semi-circular canal can be affected by abnormalities. If you have semi-circular canal dehiscence syndrome for example, part of the bony structure that sits over this part of the ear can be too thin or even missing completely. This in itself is known to cause pulsatile tinnitus.

Thinning or missing bone overlying the main arteries and veins running near the ear may also lead you to hear your heartbeat.

Idiopathic Intracranial Hypertension

This condition is caused by increased cerebrospinal fluid pressure around the brain. This elevated pressure can cause symptoms like headaches, double vision, pain behind the eye and pulsatile tinnitus.

Sinus Wall Abnormalities

The sigmoid sinus channel on the side of the brain receives blood from veins within the brain. Occasionally small pouches (diverticula) form and then protrude through the wall of the sigmoid sinus into the bone behind the ear, causing the rhythmic symptoms.

There can also be an absence of part of the bone that surround the sigmoid sinus, causing very similar symptoms.

These abnormalities cause pressure, blood flow and noise changes within the sigmoid sinus, resulting in pulsatile tinnitus.


Other reasons can include tumours in the head or neck, in most cases, tumours that result in pulsatile tinnitus are benign.

Perforated ear drum or glue ear can make you more aware of sounds internally.

Also increased sensitivities to sounds may make the brain more alert to normal sounds within the body.


After your initial discussion with your doctor, they may refer you for further examination.

    Imaging procedures can play an important role in diagnosing pulsatile tinnitus, including:

  • Magnetic resonance imaging (MRI)
  • Magnet resonance angiography (MRA)
  • Magnetic resonance venography (MRV)
  • Computerized tomography (CT)
  • Computerized tomographic angiography (CTA)
  • Angiography
  • Ultrasound

Sometimes imaging results do not reveal abnormalities and further examination and investigation is necessary. Blood tests may also be needed to rule out anaemia or thyroid problems.


If a specific cause is found, this may point to a specific solution. For example, anaemia can be treated with medication or blood transfusion, glue ear can be treated with grommets, perforations of the ear drum can be closed with grafts and narrowed segments of artery can be repaired.

Some causes are more difficult to treat, if the pulsatile tinnitus is due to a specific blood vessel, it might not be safe or possible to safely deal with this.

There isn’t always a clear treatable cause for pulsatile tinnitus, however as with normal tinnitus there are a variety of methods to manage the condition successfully.

Sound therapy

You can find a variety of sound therapy options within the T-Minus app. Sound therapy can be a great controllable way to manage and even reduce tinnitus symptoms. Read more about sound therapy:


Tinnitus of all sorts can have traumatic psychological effects. It can be really helpful to discuss these with a counsellor, who can also give you tools to support your ongoing management of the condition.

Cognitive Behavioural Therapy (CBT)

Another very worthwhile approach is the use of Cognitive Behavioural Therapy (CBT). This therapy style is designed to re-establish the connections between your behaviours and their associated results. You will work with your therapist to form new methods for dealing with your symptoms and enable you to regain control of your auditory environment again. Although face to face appointments are generally preferred, there are various online tools that facilitate CBT from home.

Mindfulness meditation

Mindfulness and meditation are great practices that you can easily implement into your routine. Head to the T-Minus app for some of our own guided meditations and the link below to our guide to getting started.