What Is Pulsatile Tinnitus?
To understand Pulsatile Tinnitus, one must first understand what exactly tinnitus means. Tinnitus is the name given to a condition in which an individual hears a sound in the ear, usually ringing or whistling sound, without any source for the sound. Sometimes, the sound could resemble that of twittering of birds or that of your heart beating. This sound may come and go but when it is present it tends to be pretty annoying and distracting. Now coming to Pulsatile Tinnitus, it is a form of tinnitus in which the affected individual hears a rhythmical sound resembling that of a heartbeat. This form of tinnitus can be identified easily than the other forms of tinnitus and the same is true for the cause of it. Affected individual may experience pulsatile tinnitus or beating sound of the heart in both ears or in some cases only one ear. They may experience beating sound of the heart in the ear this while lying down or sleeping on one side.
What Can Cause Pulsatile Tinnitus Or Heartbeat Sound In Ears?
Pulsatile Tinnitus or heartbeat sound in ears is usually caused due to an apparent change in blood flow to the vessels which are present near the ears. Some of the vessels which may cause a Pulsatile Tinnitus are the large arteries and veins in the neck and base of skull and the smaller vessels in the ear itself. This alteration in blood flow can be due to the following factors:
Generalized Increased Blood Flow: It is observed that blood that flows faster tends to make more noise than blood that tends to flow a bit slowly. The rate of the flow of blood can increase due to many causes like heavy strenuous activities or during pregnancy. Blood flow can also increase in individuals who have medical conditions like anemia or an overactive thyroid.
Localized Increased Blood Flow: At times, the blood flow is faster only in a single vessel instead of in a generalized fashion. This can be explained by citing an example in which during development of a fetus there is an artery in the middle ear called the stapedial artery which closes as the pregnancy progresses but in some cases this does not happen and in such cases flow of blood adjacent to the ear structures can result in Pulsatile Tinnitus. Another cause of Pulsatile Tinnitus can be benign tumors of the head and neck.
Turbulent Blood Flow Causing Pulsatile Tinnitus: This happens when the inner part of the blood vessels become irregular thus causing turbulence during blood flow which results in production of a sound causing Pulsatile Tinnitus. The vessels usually become irregular because of a condition called atherosclerosis in which the arteries become hard.
Altered Awareness: In case if an individual has conditions like a perforated eardrum, then that individual will tend to hear more sounds from inside of the body since the external hearing becomes impaired. Also increased sensitivity in the auditory pathway tends to alert the brain to the sounds of the blood vessels.
Other Causes of Pulsatile Tinnitus: There are some other causes of Pulsatile Tinnitus or heartbeat sound in ears as well like there is a medical condition called idiopathic intracranial hypertension in which there are frequent headaches and visual impairment along with Pulsatile Tinnitus. This condition is found usually in overweight individuals. The root cause of this condition still remains unknown.
How Is Pulsatile Tinnitus Diagnosed?
In order to diagnose Pulsatile Tinnitus, the treating physician will begin by taking a history of the individual as to the duration of these sensations. The physician will also inquire about any other medical conditions that the individual may have. The next thing will be to conduct a detailed physical examination examining particularly the ears and the neck. The physician may use a stethoscope to listen to any sounds emanating from the ear or the neck. Post this, a hearing test will be performed to look for any abnormalities in the individual's hearing capability. The physician may also order some imaging studies in the form of ultrasound to look at the blood flow within the vessels of the neck. An MRI of the head and neck may also be performed to better look at the internal structures of the neck and also the ears to look for any sort of abnormalities. Apart from this, an MRA may also be performed to look at the veins and arteries to look for any sort of irregularities or hardening of the arteries causing Pulsatile Tinnitus. A CT Angiogram may also be done for this purpose. Some of the other studies that may be done to investigate the cause of Pulsatile Tinnitus are Blood tests to rule out conditions like anemia or hyperthyroidism, which are quite common causes of Pulsatile Tinnitus. In case if an idiopathic intracranial hypertension is suspected by the physician, then the individual may need referral to other specialists such as ophthalmologists or neurologists who may then investigate this further with their own set of investigative studies.
What Are Treatments For Pulsatile Tinnitus?
The treatment for Pulsatile Tinnitus or heartbeat sound in ears is based on the underlying cause for the condition. In case if Pulsatile Tinnitus is caused due to anemia then regular blood transfusions and medications directed towards treatment of anemia is good enough to treat the Pulsatile Tinnitus. In case of overactive thyroid causing this condition then treatment for that can treat the Pulsatile Tinnitus. If the tinnitus is caused due to a perforated eardrum then these perforations need to be closed by utilizing grafts. If turbulent blood flow due to hardening of the arteries is suspected for causing Pulsatile Tinnitus then repair of these narrowed and hardened arteries is required so that blood flow becomes smooth again and the Pulsatile Tinnitus is cured. In some instances, despite knowing the cause, treatment may not cure the tinnitus like in the case of a specific blood vessel causing Pulsatile Tinnitus which cannot be repaired just because of the location of the vessel. In some instances where there is no identifiable cause for the Pulsatile Tinnitus then the following therapies might be useful in controlling the tinnitus: Sound Therapy, relaxation techniques, cognitive behavioral therapy, psychological counseling, meditation, yoga and in some cases Tinnitus Retraining Therapy which has been found to be helpful for controlling symptoms caused by Pulsatile Tinnitus.