pulsatile tinnitus symptoms and causes

Symptoms and causes of Pulsatile Tinnitus

Pulsatile tinnitus (PT) is the perception of rhythmic, pulse-synchronous sounds in the ear, often linked to various vascular, neurologic, and systemic conditions. This comprehensive overview explores the diverse causes of PT, including arterial and venous origins such as cervical carotid stenosis, fibromuscular dysplasia, idiopathic intracranial hypertension, and venous sinus thrombosis.

Book your consultation

Headaches, dizziness, hearing loss, ear pressure, and more

Symptoms of Pulsatile Tinnitus

Symptoms

Headaches

Frequently occurring, especially in cases related to increased intracranial pressure. Studies show that up to 30% of patients with benign intracranial hypertension report pulsatile tinnitus. Pulsatile tinnitus in patients with benign intracranial hypertension (BIH) occurs due to the increased intracranial pressure affecting the blood flow within the vessels near the ear. Specifically, the elevated pressure can cause turbulent blood flow in the dural venous sinuses, which are large veins that drain blood from the brain. This turbulence can create rhythmic, pulsating sounds that the patient perceives as pulsatile tinnitus.

Dizziness or Lightheadedness

Commonly associated with vascular anomalies or hypertension, affecting up to 20% of patients. These symptoms occur due to compromised blood flow or pressure regulation in the brain, which can disrupt the normal function of the vestibular system responsible for balance. Patients may experience a sensation of spinning, unsteadiness, or faintness, which can significantly impact daily activities and overall quality of life. Effective management often requires addressing the underlying vascular issues or hypertension through medication, lifestyle changes, or in some cases, surgical intervention.

Hearing Loss

May occur in conjunction with the pulsatile sound, particularly if the cause is related to vascular issues affecting the auditory system. Approximately 10-15% of patients with pulsatile tinnitus report some degree of hearing loss. This hearing loss is often due to the disrupted blood flow or pressure changes affecting the inner ear structures or auditory pathways. The combined presence of pulsatile tinnitus and hearing loss can be particularly distressing for patients, as it not only affects their hearing but also their ability to concentrate and sleep. Treatment focuses on managing the underlying vascular conditions and may include medications, lifestyle modifications, or surgical options to improve both tinnitus and hearing function.

Ear Fullness or Pressure

A sensation of fullness or pressure in the ear, often linked to venous abnormalities or structural issues, reported by about 25% of affected individuals. The primary symptom of pulsatile tinnitus is a rhythmic pulsing sound in the ears, which often aligns with the individual’s heartbeat. This can manifest as a low humming, a soft whooshing, or a more distinct thumping sound. Unlike the constant ringing or buzzing associated with non-pulsatile tinnitus, the noise heard with pulsatile tinnitus has a clear beat, making it seem as though one’s heart has found a voice within the ear.

Visual Disturbances

Such as blurring or double vision, are common in conditions like benign intracranial hypertension. Visual symptoms are reported by 40-50% of patients with this condition. These disturbances occur due to increased intracranial pressure compressing the optic nerves, leading to swelling (papilledema) and impaired visual function. Patients may experience transient visual obscurations, photopsia (seeing flashes of light), or even permanent vision loss if the condition is not adequately managed. Addressing the underlying intracranial pressure through medications, weight management, or surgical interventions is crucial to prevent long-term visual impairment and improve overall outcomes.

Neck Pain or Discomfort

May indicate a structural abnormality such as Eagle syndrome, where elongated styloid processes compress vascular structures, noted in 5-10% of cases. This compression can lead to pain and discomfort in the neck, often radiating to the face and ears, and may also contribute to symptoms like pulsatile tinnitus. The condition can be diagnosed through imaging studies, and treatment may involve pain management, physical therapy, or surgical correction to relieve the compression and associated symptoms. Addressing these structural issues is essential for alleviating neck pain and improving the patient’s overall quality of life.

Palpitations

Awareness of one’s heartbeat, which can be more pronounced in cases of systemic hypertension or anxiety, affecting approximately 15-20% of patients. Pulsatile tinnitus comes off as a beating pulse in your ear because it is typically linked to blood flow changes or issues within the vessels near the ear. The rhythmic nature of pulsatile tinnitus, mirroring the heartbeat, is due to the direct correlation with the cardiovascular system’s pulsatile flow of blood. Since the ear is highly sensitive to sound vibrations, any irregularities in the nearby blood vessels’ flow can manifest as a distinct beating pulse, heard internally.

Our mission is to revolutionize pulsatile tinnitus care by providing advanced diagnostics and personalized treatments to restore peace and well-being swiftly.

Dr. Zachary Barnard

Neurosurgeon

Venous and arterial pulsatile tinnitus, other causes, medical causes, and associated pathologies

Causes of pulsatile tinnitus

Venous Pulsatile Tinnitus

Idiopathic Intracranial Hypertension (IIH) or Pseudotumor Cerebri

Elevated intracranial pressure without an obvious cause.
Symptoms: Pulsatile tinnitus, headache, visual disturbances, and papilledema.

Intracranial Hypertension Secondary to Venous Stenosis

Stenosis of the cerebral venous sinuses leading to increased intracranial pressure.
Symptoms: Pulsatile tinnitus, headache, and visual disturbances.

Dural Arteriovenous Fistulas (dAVFs) in the Transverse/Sigmoid Sinus

Abnormal connections between arteries and veins within the dura mater.
Symptoms: Pulsatile tinnitus, often exacerbated by head position changes. Other symptoms may include headache, neurologic deficits, and visual disturbances.

Venous Sinus Thrombosis

Blood clot formation in the cerebral venous sinuses.
Symptoms: Pulsatile tinnitus, headache, focal neurological deficits, and seizures.

Sigmoid Sinus Dehiscence

An anatomical variation where the sigmoid sinus is abnormally close to the ear canal.
Symptoms: Pulsatile tinnitus, often synchronous with heartbeat.

Glomus Jugulare Tumors

Slow-growing tumors arising from the jugular bulb or paraganglia.
Symptoms: Pulsatile tinnitus, hearing loss, vertigo, and otologic symptoms.

Carotid-Cavernous Fistulas

Abnormal communication between the carotid artery and cavernous sinus.
Symptoms: Pulsatile tinnitus, proptosis, visual disturbances, and ophthalmic symptoms.

Aneurysms of the Jugular Bulb or Internal Jugular Vein

Aneurysmal dilatation of the jugular bulb or internal jugular vein.
Symptoms: Pulsatile tinnitus, may be associated with other neurological symptoms.

Jugular Bulb Abnormalities

Anomalous jugular bulb anatomy, such as a high jugular bulb.
Symptoms: Pulsatile tinnitus, often positional and related to head movement.

Meniere's Disease

Chronic inner ear disorder characterized by vertigo, hearing loss, and tinnitus.
Symptoms: Pulsatile tinnitus may occur in some cases.

Temporal Bone Vascular Anomalies

Abnormalities in the blood vessels within the temporal bone.
Symptoms: Pulsatile tinnitus, hearing loss, and other otologic symptoms.

Venous Hum

Benign, continuous low-frequency humming sound associated with venous blood flow.
Symptoms: Pulsatile tinnitus, often positional, and typically benign.

Arterial Pulsatile Tinnitus

Arteriovenous Malformations (AVMs) and Arteriovenous Fistulae (AVFs)

Aberrant connections between arteries and veins.
Symptoms: Middle meningeal arteriovenous fistulae (AVFs) and carotid-cavernous fistula are examples that can cause pulsatile tinnitus.

AVFs of the Sigmoid/Transverse Sinus

Dural arteriovenous fistulas involving the sigmoid and transverse sinuses.
Symptoms: Can cause pulsatile tinnitus; endovascular treatment may lead to resolution.

Cervical Carotid Stenosis

Stenosis (narrowing) of the internal carotid artery (ICA) in the neck.
Symptoms: May present with partial Horner syndrome, unusual neck pain or headache, and cerebral or retinal ischemia.

Petrous Carotid Aneurysm

Aneurysm of the petrous segment of the carotid artery.
Symptoms: Can cause conductive and sensorineural hearing loss, epistaxis, headache, and pulsatile tinnitus.

Paragangliomas

Carotid Body Tumor: Neuroendocrine neoplasms originating from the carotid body, may cause pulsatile tinnitus.

Internal Carotid Artery Dissection

Dissection of the internal carotid artery, often resulting from a spontaneous or traumatic tear in the arterial wall.
Symptoms: Can cause pulsatile tinnitus, unilateral headaches, posterior cervical pain, cranial nerve palsies, and cerebral or retinal ischemia.

Fibromuscular Dysplasia (FMD)

Nonatherosclerotic angiopathy leading to arterial tortuosity, stenosis, aneurysms, and dissections.
Symptoms: May present with headache, vertigo, cerebral infarct, or transient ischemic attack. Pulsatile tinnitus reported in some cases.

Petrous Carotid Stenosis

Atherosclerotic disease affecting the petrous segment of the internal carotid artery, which passes through the temporal bone.
Symptoms: Can cause turbulent flow in the region, leading to pulsatile tinnitus.

Petrous Carotid Dissection

Dissection of the intrapetrous internal carotid artery.
Symptoms: May present with deafness, vertigo, facial nerve weakness, and nausea. Pulsatile tinnitus can be the sole presenting symptom.

Cavernous Carotid Dissection

Dissection of the intradural intracranial internal carotid artery at the carotid cavern.
Symptoms: Less often associated with pulsatile tinnitus; may be linked to trauma or underlying conditions.

Superior Sagittal Sinus Fistula

Abnormal communication between the superior sagittal sinus and other veins.
Symptoms: Rare, but can be associated with pulsatile tinnitus.

Paget Disease

Progressive disorder affecting bone remodeling in the skull, leading to pulsatile tinnitus.

Other Causes of Pulsatile Tinnitus

Superior Semicircular Canal Dehiscence

PT arising from dehiscence of the superior semicircular canal can be unilateral or bilateral. Associated symptoms include Tullio phenomenon, chronic disequilibrium, and noise- and pressure-evoked vertigo. Caution is needed to avoid misdiagnosis of other similar diseases such as otosclerosis, Meniere disease, benign paroxysmal positional vertigo, and perilymph fistulae. Surgical treatment (plugging and/or resurfacing of the dehiscent superior semicircular canal) through subtemporal craniotomy or transmastoid approach is effective, offering high rates of complete symptom resolution.

Tegment Defects

Structural weaknesses or openings in the tegmen, which is the thin, bony covering that separates the cranial cavity from other structures, such as the middle ear or mastoid air cells. The tegmen is particularly important in the temporal bone, where it forms part of the skull base.

Encephaloceles

Characterized by the protrusion of brain tissue and the surrounding membranes through openings or defects in the skull. As a sac-like protrusion containing brain tissue, cerebrospinal fluid, and meninges (protective membranes) extends through the skull defect.

Chiari Syndrome (Type I Arnold–Chiari Malformation)

Type I Arnold–Chiari malformation is a rare cause of pulsatile tinnitus (PT). Congenital stenosis of the Sylvian aqueduct can also lead to PT. Stenosis of the Sylvian duct is believed to create turbulent blood flow in the dural venous sinuses and elevate intracranial pressure. PT from Chiari malformations typically presents in patients aged 25 to 35 with symptoms like headaches, dizziness, sensory deficits, nystagmus, neck pain, extremity weakness, and vertigo. Sensorineural hearing loss may occur due to the masking effect of PT. Decompressive surgery has shown a 75% success rate in cases of Chiari and congenital sylvian stenosis-derived PT and sensorineural hearing loss.

Medical Causes of Pulsatile Tinnitus

Vascular Causes

Atherosclerosis: Narrowing and hardening of the arteries, affecting blood flow.
Hypertension: High blood pressure can lead to turbulent blood flow.

Cardiovascular Causes

Aortic Regurgitation: Backflow of blood in the heart.
Turbulent Blood Flow: Various cardiac conditions can lead to turbulent blood flow.

Hematologic Causes

Anemia: Reduced red blood cell count can affect blood viscosity.
Polycythemia Vera: Overproduction of red blood cells can alter blood flow dynamics.

Metabolic Causes

Thyroid Disorders: Both hyperthyroidism and hypothyroidism can be associated with pulsatile tinnitus.
Diabetes: Poorly controlled diabetes may affect blood vessels and circulation.

Neurologic Causes

Multiple Sclerosis: Autoimmune disorder affecting the central nervous system.

Medication-Induced Causes

Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, or certain diuretics, may contribute to pulsatile tinnitus.

Systemic Causes

Systemic Lupus Erythematosus (SLE): An autoimmune disorder that can affect various organs, including blood vessels.
Granulomatosis with Polyangiitis (GPA): Inflammation of blood vessels.

Middle Ear Pathology

Conditions affecting the middle ear, such as Eustachian tube dysfunction or middle ear infections.

BLogs

LATEST ARTICLES

View All

Sep 28, 2024

Symptoms and causes of Pulsatile Tinnitus

Symptoms of Pulsatile Tinnitus

Symptoms

Causes of pulsatile tinnitus

Venous Pulsatile Tinnitus

Arterial Pulsatile Tinnitus

Other Causes of Pulsatile Tinnitus

Medical Causes of Pulsatile Tinnitus

LATEST ARTICLES

Understanding Pulsatile Tinnitus: Causes and Symptoms in Los Angeles

Top Pulsatile Tinnitus Treatments Available in California

Living with Pulsatile Tinnitus: Coping Strategies for Los Angeles Residents

Get treatment for pulsatile tinnitus

Symptoms and causes of Pulsatile Tinnitus

Symptoms of Pulsatile Tinnitus

Symptoms

Headaches

Dizziness or Lightheadedness

Hearing Loss

Ear Fullness or Pressure

Visual Disturbances

Neck Pain or Discomfort

Palpitations

Causes of pulsatile tinnitus

Venous Pulsatile Tinnitus

Idiopathic Intracranial Hypertension (IIH) or Pseudotumor Cerebri

Intracranial Hypertension Secondary to Venous Stenosis

Dural Arteriovenous Fistulas (dAVFs) in the Transverse/Sigmoid Sinus

Venous Sinus Thrombosis

Sigmoid Sinus Dehiscence

Glomus Jugulare Tumors

Carotid-Cavernous Fistulas

Aneurysms of the Jugular Bulb or Internal Jugular Vein

Jugular Bulb Abnormalities

Meniere's Disease

Temporal Bone Vascular Anomalies

Venous Hum

Arterial Pulsatile Tinnitus

Arteriovenous Malformations (AVMs) and Arteriovenous Fistulae (AVFs)

AVFs of the Sigmoid/Transverse Sinus

Cervical Carotid Stenosis

Petrous Carotid Aneurysm

Paragangliomas

Internal Carotid Artery Dissection

Fibromuscular Dysplasia (FMD)

Petrous Carotid Stenosis

Petrous Carotid Dissection

Cavernous Carotid Dissection

Superior Sagittal Sinus Fistula

Paget Disease

Other Causes of Pulsatile Tinnitus

Superior Semicircular Canal Dehiscence

Tegment Defects

Encephaloceles

Chiari Syndrome (Type I Arnold–Chiari Malformation)

Medical Causes of Pulsatile Tinnitus

Vascular Causes

Cardiovascular Causes

Hematologic Causes

Metabolic Causes

Neurologic Causes

Medication-Induced Causes

Systemic Causes

Middle Ear Pathology

LATEST ARTICLES

Understanding Pulsatile Tinnitus: Causes and Symptoms in Los Angeles

Top Pulsatile Tinnitus Treatments Available in California

Living with Pulsatile Tinnitus: Coping Strategies for Los Angeles Residents

Get treatment for pulsatile tinnitus

SUBSCRIBE TO OUR NEWSLETTER