Pulsatile tinnitus is a rare but often debilitating medical condition. People who have this disorder may find their lives negatively affected in a variety of ways. However, there is hope. Understanding this condition is the first step to getting it diagnosed and treated.
What Is Pulsatile Tinnitus?
Pulsatile is different from normal tinnitus because it manifests itself as a rhythmic noise in the ears that occurs at the same rate as the pulse. People who suspect they may have it can feel the pulse on their wrist and see if it coincides with the sound in their ears. Like other types of tinnitus, it is not caused by any external sounds. It may be constant or occur only at times. Sufferers may have pulsatile tinnitus in one ear or in both.
Pulsatile tinnitus is also called vascular tinnitus. This is due to the fact that it almost always has a vascular cause.
Pulsatile Tinnitus Symptoms – What to Look Out For
The main symptom of pulsatile tinnitus is simply a rhythmic sound in the ear that coincides with the pulse. It’s important to remember that a person can have other types of tinnitus at the same time. If one’s tinnitus only sometimes follows the beat of their pulse, they still likely have this condition.
What Causes Pulsatile Tinnitus?
There are several different pulsatile tinnitus causes, although most have to do with vascular issues in the head. In all cases, there is a change in blood flow through the arteries and veins at the side of the head or a change in how much this blood flow is perceived. A change in blood flow can have several different causes, including:
- An increase in blood flow through the entire body due to anemia or hyperthyroidism
- An increase in blood flow in just the head, including inborn vessel abnormalities or tumors in the head or neck
- An increase in the turbulence in the blood vessels of the head, often caused by atherosclerosis
Lastly, pulsatile tinnitus is sometimes caused not by a change in blood flow but by a change in how the ears and brain perceive this blood flow. The ears may have somehow become over sensitized to the normal blood flow in the skull and neck. This is usually due to loss of conductive hearing or a change in the brain’s auditory pathway.
How Is Pulsatile Tinnitus Diagnosed?
Pulsatile tinnitus is usually diagnosed simply from the patient’s report that they are hearing rhythmic sounds at the same time that their pulse occurs. Diagnosing the cause of pulsatile tinnitus causes can be more complicated. However, it is usually much easier for doctors to find a single, treatable cause for pulsatile tinnitus than for other kinds of tinnitus.
Because pulsatile tinnitus usually has a vascular cause, the physician will test the blood flow through the arteries and veins of the skull. These tests include:
- Physical examination of the head and neck, usually with a stethoscope to hear turbulent or loud blood flow
- Hearing tests to rule out conductive hearing loss
- CT scan with contrast
- Magnetic resonance angiography (MRA), which is an MRI that looks only at blood flow
- X-ray angiography
- Blood work to look for anemia and hyperthyroid
Most doctors will not do all of these tests, but pick the one or two that they feel are more likely to find the root cause of the pulsatile tinnitus based on the patient’s history and the results of the doctor’s physical examination.
Pulsatile Tinnitus Treatment
Once a person is diagnosed, they will want to know how they can stop pulsatile tinnitus. Treatment for pulsatile tinnitus will generally include treating the cause, if one has been found. For example, if the person was found to be anemic, they will be prescribed iron supplements for tinnitus. If there is an abnormality in the ear, it will be surgically repaired. If the pulsatile tinnitus is caused by an abnormality in a blood vessel, this may or may not be reparable depending on what blood vessel is affected and where it is located.
If a person is diagnosed with idiopathic or benign pulsatile tinnitus, meaning that no physical cause has been found, there are a variety of support services that can help them manage and live with this condition. Sound therapy, relaxation, and even psychotherapy have all been found to help. Some therapists specialize in Tinnitus Retraining Therapy which helps people to retrain their brains not to perceive the sound.
While a diagnosis of pulsatile tinnitus can be devastating, there is hope. Doctors usually are able to find the root cause and treat it. In many cases, pulsatile tinnitus is a valuable symptom of a more dangerous disorder that can be treated successfully because it was found in its earliest stages. As with all medical conditions, patients should educate themselves and advocate for the best possible care.
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