Differential Diagnosis for a 58-Year-Old Female Hearing Heart Sounds in Her Ears When Lying Down
- Single Most Likely Diagnosis
- Benign External Auditory Canal (EAC) Sounds or Pulsatile Tinnitus: This condition is characterized by hearing one's own heartbeat or sounds that are synchronous with the heartbeat, often due to the proximity of the ear to major blood vessels. Lying down can exacerbate the condition due to changes in blood flow and pressure. The patient's age and the absence of other symptoms make this a plausible explanation.
- Other Likely Diagnoses
- Anemia: Anemia can cause an increase in cardiac output, leading to more pronounced heart sounds that might be audible to the patient, especially in quiet environments or when lying down.
- Thyroid Disorders: Hyperthyroidism, in particular, can lead to increased heart rate and cardiac output, potentially making heart sounds more noticeable.
- Mitral Valve Prolapse: Although often asymptomatic, mitral valve prolapse can sometimes cause palpitations or awareness of heart sounds, especially if there is associated mitral regurgitation.
- Do Not Miss Diagnoses
- Aortic Stenosis or Other Valvular Heart Diseases: Severe valvular diseases can lead to significant alterations in blood flow, potentially causing audible sounds. Although less common, missing these conditions could have serious implications.
- Carotid Artery Stenosis: Significant stenosis can lead to turbulent blood flow, which might be audible as a bruit or pulsatile tinnitus, particularly when lying down.
- Glomus Jugulare Tumor: A rare tumor of the jugular bulb that can cause pulsatile tinnitus due to its proximity to the ear and major blood vessels.
- Rare Diagnoses
- Patent Eustachian Tube (PET): Although more commonly associated with hearing breathing sounds, a PET could potentially allow for the transmission of internal sounds, including heart sounds, to the ear.
- Vascular Malformations or Fistulas: Abnormal connections between arteries and veins can lead to turbulent blood flow, potentially causing audible sounds.
- 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, which can lead to a variety of auditory symptoms, including hearing internal sounds like heartbeat or breathing.