Pulsatile Tinnitus
PULSATILE TINNITUS
In some forms of tinnitus, the perceived sound occurs rhythmically or in pulses. This is called pulsatile tinnitus or sometimes intermittent tinnitus. Usually the pulsating sound occurs synchronous with the heart rate. Pulsatile tinnitus is also known as vascular tinnitus because the sound correlates with blood flow. About 3% of tinnitus cases involve pulsatile tinnitus.
Pulsatile tinnitus is distinct from continuous tinnitus whereby the sound is more or less non-stop. It is possible to have both continuous and pulsatile tinnitus simultaneously. In these cases, it is usually the unrelenting pulsating sounds that are found to be more distracting.
CAUSES OF PULSATILE TINNITUS
- Altered Blood Flow - Pulsatile tinnitus is commonly found to be the result of increased blood flow to the blood vessels within the head and neck region. Alternatively, it may be cause by a narrowing of the opening of the blood vessel which in turn causes increased turbulence of blood flow which is heard by the individual. The resulting sound is perceived as a whooshing sound in the ears. In some instances the sound can be heard or detected by others. In other words the person’s body is actually making a sound caused by unusual turbulent blood flow in the head/neck area creating a sound that emanates from the ear canal. When the sound emanating from the ear canal is audible by others, it is known as objective tinnitus. Subjective or continuous tinnitus is the more common form whereby the sound is only perceived by the tinnitus sufferer. Continuous tinnitus usually results from damage to the cochlea and/or hearing nerve endings. Typically, the term tinnitus refers to subjective tinnitus and objective tinnitus is referred to as a somatosound.
- Arterial Turbulence – The most common cause of pulsatile tinnitus is arterial turbulence, a noisy blood flow caused by plaques or kinks in the arteries in the head or neck. It can be made worse if there is also hypertension. Many forms of pulsatile tinnitus are treatable. Here are some other causes.
- Atherosclerosis – Atherosclerosis is the narrowing of the artery caused by cholesterol build-up on the artery wall. This leads to a reduction or narrowing of the diameter of the artery resulting in turbulent blood flow that produces pulsatile tinnitus. This commonly occurs in older patients that have a history of hypertension, high cholesterol, diabetes, angina and smoking.
- Benign Intracranial Hypertension – Benign intracranial hypertension (BIH) is a condition where there is increased pressure of the cerebrospinal fluid which surrounds the brain. Tinnitus is just one of many symptoms that accompanies the pressure changes in the brain. Other symptoms include fullness of the ear, hearing loss, dizziness, headaches and visual disturbances. Frequently these patients are younger females who are overweight.
- Intracranial Lesions – Various types of intracranial lesions of the vasculature within the brain can lead to the symptoms of pulsatile tinnitus. Arteriovenous malformations, are abnormal connections between arteries and veins. In these instances, the blood flows directly from a high pressure artery to a lower pressure vein without going through the capillaries. An abnormal collection of malformed arteries and veins sometimes occur within the cranial cavity near the auditory nerve. Atrial pulsations against the auditory nerve can stimulate the nerve, causing pulsatile tinnitus. An aneurysm is an abnormal widening of a portion of an artery due to weakness in the wall of the blood vessel. Either aneurism or arteriovenous malformation can lead to bleeding in the brain and can be extremely dangerous.
- Tumors – Glomus or vascular tumors can occur in the ear or just below the ear near the base of the skull. These benign tumors consist of a mass of entangled blood vessels. This can cause pulsatile tinnitus and hearing loss.
- Fluid Build Up – Ear infections, inflammation and Eustachian tube dysfunction can cause fluid to accumulate in the middle ear. Normally the middle is filled with air. Fluid in the middle ear can lead to pulsatile tinnitus, a loss in hearing, a feeling of fullness of the ear and pain.
- Jugular Vein – Pulsating venous hum is caused by turbulent flow of blood through the jugular vein. The jugular vein, which carries blood from the brain to the heart, passes by the middle ear. Turbulent flow in the jugular vein can be heard in the middle ear as a pulsating or continuous hum. Abnormal blood flow through the jugular vein is often associate with individuals who are anemic, have thyroid conditions or are pregnant.
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