Pulsatile tinnitus: why I hear my pulse and when to be concerned

When the noise in your ears has a rhythm — a pulse that coincides with your heartbeat — it is a different type of tinnitus and deserves attention. Not to alarm you, but because it often has a specific cause that can be found and addressed.

How it differs from ordinary tinnitus

Most tinnitus is subjective: the sound is generated in the auditory system and has no physical source. Pulsatile tinnitus is different — it is usually a real sound, caused by the movement of blood through a vessel near the middle or inner ear. That is why sometimes the doctor can hear it with a stethoscope.

The most common causes

• Vascular causes: narrowing of an artery or venous sinus, a fistula or arteriovenous malformation, rarely a vascular tumour.
• Raised intracranial pressure — particularly in women over 50 with increased weight.
• High blood pressure and anaemia, which intensify turbulent flow.

Precisely because these causes are specific, pulsatile tinnitus leads to identification of a clear cause in 44–91% of cases — and many of them respond to treatment.

When to see a doctor

Newly appearing pulsatile tinnitus deserves examination by an ENT specialist within a few days. Seek urgent help if it is accompanied by severe headache, blurred vision, dizziness or weakness on one side of the body.

What to expect at the appointment

The doctor will examine your ears and neck, measure your blood pressure and usually order vascular imaging (MRI or CT angiography). If a treatable cause is found, eliminating it often eliminates the noise too.

In short

Pulsatile tinnitus is not like ordinary tinnitus — it usually has a physical source and a specific cause. And that is the good news: where there is a cause, there is often a solution. Do not ignore it, but do not panic — book an appointment.