Differential Diagnosis for Pulsating, Cracking, and Wooshing Sounds in Bilateral Ears

Single Most Likely Diagnosis

• Tinnitus: This condition is characterized by the perception of noise or ringing in the ears when no external sound is present. The symptoms described, such as pulsating, cracking, and wooshing sounds, are common manifestations of tinnitus. The lateralization (L>R) could indicate a difference in the severity or perception of the condition between the two ears.

Other Likely Diagnoses

• Eustachian Tube Dysfunction: This condition affects the tube that connects the middle ear to the back of the nose and throat. Dysfunction can lead to feelings of fullness, hearing loss, and unusual sounds, including cracking or popping noises, especially when swallowing or yawning.
• Middle Ear Myoclonus: This rare movement disorder of the middle ear muscles can cause clicking or cracking sounds that are often rhythmic and can be synchronized with the patient's heartbeat.
• Palatal Myoclonus: Similar to middle ear myoclonus but involves the muscles of the palate, leading to clicking sounds that can be perceived in the ears.

Do Not Miss Diagnoses

• Carotid Artery Stenosis or Dissection: Although less common, pulsatile tinnitus can be a symptom of carotid artery stenosis or dissection. The pulsating nature of the sound could be indicative of a vascular issue, making this a critical diagnosis not to miss due to its potential for severe consequences, including stroke.
• Glomus Jugulare Tumor: A rare, benign tumor located in the jugular bulb can cause pulsatile tinnitus due to its proximity to the ear and its vascular nature. Early detection is crucial for effective management.
• Venous Hum: An abnormal flow in the jugular vein can cause a humming or wooshing sound, especially noticeable in quiet environments. While not typically dangerous, it can significantly affect quality of life.

Rare Diagnoses

• Superior Semicircular Canal Dehiscence: A rare condition where there is an abnormal opening in the bone overlying the superior semicircular canal of the inner ear. This can lead to a variety of auditory and vestibular symptoms, including hearing internal sounds like one's own heartbeat or breathing.
• Patulous Eustachian Tube: A condition where the Eustachian tube remains open, leading to an echoing or resonance of internal sounds, such as breathing or the sound of one's own voice, in the ear.

Each of these diagnoses has the potential to explain the symptoms of pulsating, cracking, and wooshing sounds in the bilateral ears, with varying degrees of likelihood and urgency for diagnosis and treatment.