From the Guidelines
Hearing a heartbeat in your ear is called pulsatile tinnitus (PT). This condition occurs when you hear rhythmic noises that match your heartbeat, as described in the 2023 update of the ACR Appropriateness Criteria for tinnitus 1. Pulsatile tinnitus differs from regular tinnitus, which typically involves hearing constant sounds like ringing or buzzing.
Key Characteristics of Pulsatile Tinnitus
- The pulsating sound happens because blood vessels near your ear are either experiencing increased blood flow or have developed an abnormality that makes normal blood flow more noticeable.
- Common causes include high blood pressure, anemia, atherosclerosis (narrowed arteries), or structural abnormalities in blood vessels.
- Pulsatile tinnitus can be either subjective or objective, and it is essential to classify tinnitus as pulsatile or nonpulsatile to optimize the imaging workup, given different diagnostic considerations for each 1.
Importance of Medical Evaluation
If you experience pulsatile tinnitus, you should consult a healthcare provider for proper evaluation, as it can sometimes indicate underlying vascular conditions that need treatment.
- Your doctor might recommend tests like an MRI, CT scan, or ultrasound to identify the cause.
- Treatment typically focuses on addressing the underlying condition rather than the tinnitus itself, as recommended by the American Academy of Otolaryngology and Head and Neck Surgery Foundation (AAO-HNS) guidelines 1.
From the Research
Definition and Characteristics
- Pulsatile tinnitus is a sound from within the body, mostly of vascular origin, that stimulates the patient's hearing in the same way as an external sound does, generally at the same pace as the pulse 2.
- It is characterized by hearing the heartbeat or respiration in one or both ears 3.
Causes and Diagnosis
- The causes of pulsatile tinnitus can be categorized into structural, metabolic, and vascular groups 4.
- Vascular causes of pulsatile tinnitus include idiopathic intracranial hypertension and dural arteriovenous fistulas 4.
- A thorough evaluation can identify an underlying cause of pulsatile tinnitus in more than 70% of patients 4.
- Diagnostic evaluation may include a targeted history and physical examination, comprehensive audiologic evaluation, and neuroimaging in certain cases 5, 6.
Treatment and Management
- Treatment options for pulsatile tinnitus may include surgery, such as Teflon interpositioning between the vascular loop and the cochlea 3.
- Cognitive behavior therapy has been shown to improve quality of life in patients with tinnitus 5.
- Sound therapy and tinnitus retraining therapy are treatment options, but evidence is inconclusive 5.