How is whooshing head noise related to anemia treated?

Treatment of Whooshing Head Noise from Anemia

The whooshing sound in your head from anemia is treated by correcting the underlying anemia through iron supplementation, which should normalize hemoglobin levels and eliminate the auditory symptom caused by increased blood flow velocity through vessels near the ear.

Understanding the Mechanism

The "whooshing" or pulsatile sound you're experiencing is likely pulsatile tinnitus caused by turbulent blood flow in vessels near the inner ear, which occurs when anemia reduces blood viscosity and increases cardiac output to compensate for reduced oxygen-carrying capacity. Correcting the anemia resolves this symptom.

Treatment Approach

Initial Assessment and Iron Supplementation

Iron supplementation should be initiated immediately when iron deficiency anemia is confirmed, as this is the definitive treatment that will resolve both the anemia and the associated whooshing sound 1.

• For mild to moderate anemia (Hb >10 g/dL): Start with oral iron supplementation at 100-200 mg of elemental iron daily 1.

  • Ferrous sulfate 200 mg twice daily is the standard first-line treatment 1.
  • Lower doses may be equally effective and better tolerated if gastrointestinal side effects occur 1.
  • Continue oral iron for 3 months after correction to replenish iron stores 1.

• For severe anemia (Hb <8-10 g/dL) or oral iron intolerance: Intravenous iron is preferred 2.

  • Iron sucrose 200 mg can be administered intravenously over 10 minutes 1, 2.
  • Calculate total iron deficit using: Weight (kg) × (Target Hb - Actual Hb) × 2.4 + 500 mg 2.
  • Administer 200 mg twice weekly until total dose is delivered 2.

Important Clinical Considerations

The normalization of hemoglobin is an objective and auditable goal that directly impacts quality of life, including resolution of symptoms like pulsatile tinnitus 1.

• Oral iron preparations cause gastrointestinal side effects in many patients (nausea, flatulence, diarrhea) due to >90% remaining unabsorbed 1.
• Intravenous iron has become standard of care in many situations and avoids gastrointestinal complications 1.
• Monitor hemoglobin after 1-2 weeks to assess response 2.

Addressing Underlying Causes

While treating the anemia itself, investigate and address the root cause:

• In premenopausal women <40 years: Menstrual blood loss is the most common cause; iron supplementation alone may suffice 3.
• In men and postmenopausal women: Gastrointestinal evaluation with bidirectional endoscopy (gastroscopy and colonoscopy) is mandatory to rule out malignancy 1, 3.
• Screen for celiac disease with transglutaminase antibody testing, as malabsorption can cause persistent iron deficiency 3.
• Test for H. pylori if anemia persists or recurs after normal endoscopy, as eradication can reverse anemia 1.

Monitoring and Follow-up

• Hemoglobin and red cell indices should be monitored at 3-month intervals for the first year after correction 2.
• Recurrence of anemia is common (>50% after 1 year) and often indicates ongoing blood loss or inflammation 1.
• The whooshing sound should resolve as hemoglobin normalizes, typically within weeks of starting effective treatment.

Common Pitfalls to Avoid

• Do not rely on faecal occult blood testing in the investigation of iron deficiency anemia—it is insensitive and non-specific 1.
• Avoid intramuscular iron as there is no evidence it is less toxic or more effective than oral or intravenous routes, and it can be painful 1.
• Do not stop treatment prematurely—continue iron for 3 months after hemoglobin normalizes to replenish stores 1.