What is Pulsatile Tinnitus?

Imagine lying down in a quiet room and suddenly hearing a rhythmic pulsing in your ear—like the echo of your heartbeat. This is a common description from individuals experiencing pulsatile tinnitus, a lesser-known but often distressing auditory condition. Unlike the more familiar form of tinnitus, which manifests as ringing or buzzing, pulsatile tinnitus is characterized by a thumping or whooshing sound that synchronizes with the heartbeat.

This unique condition falls under the category of objective tinnitus, where the sound typically originates from a physical source, often related to vascular structures near the ear. While it may be intermittent for some—appearing only during rest, exercise, or changes in posture—it can become a constant presence for others, impacting concentration, sleep quality, and emotional health.

Though pulsatile tinnitus may seem benign, it can be a red flag for underlying conditions that require medical investigation. At Sangdo Woori Internal Medicine Clinic in Seoul, under the guidance of Dr. Yoo Du-yeol, we take a thorough and individualized approach to evaluating and treating patients experiencing this phenomenon.

Why Do You Hear Your Heartbeat in Your Ear?

The ear is remarkably sensitive, especially the cochlea, which detects vibrations and converts them into signals for the brain to interpret as sound. Because major arteries and veins pass near the auditory system, any change in blood flow or vascular pressure can produce sounds that resonate within the ear. When these vibrations match the heartbeat, they are perceived as pulsatile tinnitus.

This can occur more readily in individuals with:

• Anatomical proximity of blood vessels to the auditory system

• Lower body fat, reducing the insulation between vascular structures and the ear

• Increased intracranial pressure, which can amplify internal sounds

Unlike subjective tinnitus, which is purely neurological, objective pulsatile tinnitus may occasionally be heard by a physician using a stethoscope placed near the patient’s ear or skull.

Understanding whether the tinnitus is subjective or objective is an essential first step in determining its cause and guiding appropriate treatment.

Common Causes of Pulsatile Tinnitus

Pulsatile tinnitus is most often linked to vascular anomalies or changes in blood flow near the auditory system. Some of the most common causes include:

1. Vascular Abnormalities
Conditions such as carotid artery stenosis, arteriovenous malformations (AVMs), or aneurysms can disrupt normal blood flow, creating turbulence that manifests as pulsatile tinnitus. These vascular issues may also be associated with risks such as stroke, making timely diagnosis critical.

2. Idiopathic Intracranial Hypertension (IIH)
Also known as pseudotumor cerebri, IIH causes increased pressure within the skull, often affecting the flow of cerebrospinal fluid and venous blood. This pressure can compress nearby vascular structures, producing a whooshing sound. IIH typically affects young women and may also present with visual disturbances and chronic headaches.

3. Jugular Bulb Abnormalities
The jugular bulb, a large vein near the middle ear, may sometimes be abnormally enlarged or situated higher than usual—a condition known as high-riding jugular bulb or jugular bulb dehiscence. These variations allow vascular noise to directly reach the cochlea, resulting in audible pulsations.

4. Venous Hum or Vascular Turbulence
In some cases, simple anatomical variations or compressed veins in the neck (such as the internal jugular vein) may create turbulent blood flow audible to the patient. This may worsen with changes in posture or neck position.

While many of these conditions are benign, others can be serious. Proper identification and imaging are necessary to differentiate between harmless anatomical variants and more dangerous pathologies.

Associated Medical Conditions

Pulsatile tinnitus is often a symptom linked to broader systemic health issues. Several conditions can either cause or intensify the condition:

1. Hypertension (High Blood Pressure)
Elevated blood pressure increases the force and velocity of blood through arteries. In areas near the ear, this can create turbulent flow that is interpreted by the auditory system as sound. Patients often report symptom flare-ups during periods of stress, anxiety, or physical exertion.

2. Atherosclerosis
This condition involves the narrowing and hardening of arteries due to plaque buildup. If arteries near the ear are affected, the resulting irregular blood flow may be heard as pulsatile tinnitus. This condition is particularly prevalent in older adults or those with metabolic risk factors.

3. Anemia and Hyperthyroidism
Both conditions affect blood dynamics. In anemia, reduced oxygen-carrying capacity leads to compensatory increased cardiac output, which may result in heightened vascular noise. In hyperthyroidism, elevated metabolism accelerates blood circulation, amplifying internal auditory sensations.

4. Temporal Bone Pathologies
Tumors (e.g., glomus tumors) or abnormalities in the temporal bone may compress nearby vessels or alter sound conduction pathways, generating tinnitus.

By understanding these medical relationships, clinicians can uncover hidden drivers of pulsatile tinnitus and tailor appropriate therapies.

Is Pulsatile Tinnitus Serious?

While pulsatile tinnitus is not inherently dangerous, it can be a harbinger of more serious vascular or neurological conditions. The significance of the symptom often depends on accompanying features.

Serious indicators include:

• Sudden onset

• One-sided (unilateral) tinnitus

• Associated neurological symptoms (e.g., headaches, visual changes, imbalance)

• History of cardiovascular or cerebrovascular disease

These features may suggest conditions such as vascular malformations, tumors, or intracranial hypertension, and warrant immediate diagnostic imaging.

Harmless scenarios may involve:

• Intermittent tinnitus during stress or fatigue

• Symmetrical (bilateral) pulsations

• Known benign anatomical variations

• Temporary onset linked to posture or exercise

Still, because it can be difficult to differentiate without testing, professional evaluation is essential—even for seemingly mild cases.

The Importance of Timely Evaluation

Early detection can dramatically change outcomes, particularly for vascular causes such as carotid artery stenosis, which can be asymptomatic yet carry significant stroke risk. Diagnostic clarity also helps avoid unnecessary anxiety, as many patients fear the worst before receiving a proper diagnosis.

At Sangdo Woori Internal Medicine Clinic, we provide patients with access to state-of-the-art vascular imaging and thorough clinical evaluations. Dr. Yoo Du-yeol and his team coordinate seamlessly with ENT specialists, neurologists, and radiologists to deliver accurate, comprehensive care.

Diagnostic Approach to Pulsatile Tinnitus

Proper diagnosis requires a stepwise, multidisciplinary approach. At Sangdo Woori Internal Medicine, we follow a structured process:

1. Clinical History and Physical Exam
We begin with an in-depth review of the patient's medical history, including symptom timing, duration, and associated features. Physical exams may detect bruits (vascular sounds) over the skull, neck, or ear, offering critical diagnostic clues.

2. Audiological Testing
Hearing tests help determine if hearing loss is present, and tympanometry may detect middle ear abnormalities. In some cases, the sound may be heard through a stethoscope, confirming the diagnosis of objective tinnitus.

3. Imaging Studies

We employ advanced imaging modalities, including:

• MRI/MRA to examine the brain, auditory structures, and vasculature

• CT/CTA scans to detect bony and vascular anomalies

• Doppler ultrasound for real-time blood flow evaluation

• Temporal bone CT for precise analysis of ear-related causes

These tools allow us to visualize even minute anatomical and vascular anomalies.

4. Interdisciplinary Review
Complex cases benefit from collaboration between internal medicine, ENT, and neurological specialties. At Sangdo Woori, our collaborative care model ensures nothing is overlooked.

Treatment Options for Pulsatile Tinnitus

Treatment is always tailored to the underlying cause:

Vascular Issues:

• Carotid artery disease may require angioplasty, stenting, or surgical intervention

• AVMs or aneurysms may necessitate endovascular coiling or embolization

• High blood pressure management is key to reducing vascular turbulence

Intracranial Hypertension:

• Treated with acetazolamide, weight loss, low-sodium diets, or lumbar punctures

• Shunt placement may be necessary in resistant cases

Systemic Conditions:

• Managing anemia, hyperthyroidism, or atherosclerosis often alleviates tinnitus

• Emphasis is placed on lifestyle changes, medication adherence, and ongoing monitoring

Non-Invasive Approaches:

• Sound therapy (white noise machines, ambient music)

• Cognitive Behavioral Therapy (CBT) to manage distress

• Supplements (e.g., magnesium, CoQ10) with medical supervision

Dr. Yoo Du-yeol emphasizes a holistic approach—addressing not just the physical cause but also the emotional toll of persistent symptoms.

Advancements in Diagnosis and Treatment

Technological innovations have revolutionized pulsatile tinnitus evaluation:

• High-resolution 3D imaging of the skull base and vascular pathways offers unparalleled diagnostic precision.

• Functional MRI (fMRI) is beginning to uncover how the brain processes internal sounds.

• AI-enhanced diagnostic tools are now assisting radiologists in identifying subtle anomalies missed by the human eye.

Sangdo Woori Internal Medicine Clinic stays at the forefront of these innovations by collaborating with top-tier imaging centers and integrating new protocols as they emerge.

Why Choose Sangdo Woori Internal Medicine Clinic?

Located in Dongjak-gu, Seoul, Sangdo Woori Internal Medicine Clinic is a leading center for vascular and metabolic diagnostics. Led by Dr. Yoo Du-yeol, an experienced internal medicine physician with academic roots at Chung-Ang University and Hallym University, the clinic offers:

• Advanced diagnostic technology

• Collaborative specialty care

• Personalized patient education

• Multilingual support for international patients

Our approach combines deep medical insight with compassionate, individualized care. Whether your symptoms are minor or severe, we ensure that you leave with clarity, answers, and a plan.