What is pulsatile tinnitus?

Imagine hearing the rhythmic whoosh of your pulse in your ear, beating in sync with your heartbeat. This is what happens when you have what's known as pulsatile tinnitus. 

It’s a rare form of tinnitus, which is typically characterized by ringing, clicking, or other noises in one or both ears. Pulsatile tinnitus accounts for about 1 percent of all tinnitus cases, according to the National Organization for Rare Disorders (NORD). 

“While it's often benign (not harmful), it's more likely to have an identifiable source, and may be the first sign of some kind of underlying condition,” says Rebecca Lewis, AuD, audiology director of the Adult & Pediatric Cochlear Implant Program at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, CA.  

If you have pulsatile tinnitus, it can be more than a nuisance—it can indicate an underlying health problem that merits follow-up. Here’s what you need to know if you experience a rhythmic thump in one or both ears.

Pulsatile tinnitus symptoms 

The trademark symptom of pulsatile tinnitus is when the sounds in your ear are in sync with your heartbeat, Lewis says. 

Hearing your heartbeat when you exercise is common, she notes. But with pulsatile tinnitus, “you might hear your heartbeat in your ear, even when you're just laying down, not exerting yourself,” Lewis says. 

There’s a difference between standard tinnitus and pulsatile tinnitus. 

Doctors may be able to hear it, too

When you hear the clicking or ringing of ordinary tinnitus, it’s characterized as a subjective sound—nothing is actually ringing, and others are unable to hear the sound. The sound is illusory. In contrast, pulsatile tinnitus is characterized as objective. That is, a sound is occurring in your body, and doctors may be able to hear it, according to NORD. 

With pulsatile tinnitus, you might hear your heartbeat in your ear, even when you're just laying down, not exerting yourself.

The whoosh or thump of your heartbeat in your ear may change depending on your position, such as when you turn your head or lie down, according to Northwestern Medicine. 

As with other types of tinnitus, pulsatile tinnitus can be disruptive or merely irritating. 

What causes it? 

The important thing to remember about tinnitus is that it’s not a diagnosis. That is, tinnitus is “a side effect of something else,” Lewis notes. With regular tinnitus, hearing loss is the most common culprit. Some potential underlying conditions that cause pulsatile tinnitus are: 

• Abnormal blood vessels, narrowed arteries, hardened arteries, and other vascular issues (heart disease is linked to hearing loss)
• High blood pressure 
• Superior canal dehiscence syndrome (an abnormal hole in your inner ear)
• Ruptured ear drum or excess earwax
• Tumors, including acoustic neuromas

Also, anemia, head trauma, and hyperthyroidism are also sometimes associated with pulsatile tinnitus, Lewis says. Some conditions—such as anemia and pregnancy—can lead to an uptick in how much blood your heart pumps, which can be a reason pulsatile tinnitus occurs. 

In the majority of cases of pulsatile tinnitus—70 percent—an underlying cause can be determined, per a February 2022 narrative review of the condition published in JAMA Otolaryngology Head and Neck Surgery. 

This review divvies up the causes into three groups: structural (eg, a tumor), metabolic (eg, ototoxic medications or a spasming muscle in the middle ear), and vascular (eg, carotid artery stenosis, which is when the arteries on the side of your neck get narrower). 

There is also "muscular tinnitus," which refers to pulsing tinnitus that is caused by muscular problems. It is more common in people with degenerative disorders like multiple sclerosis and amyotrophic lateral sclerosis.

What should you do if you experience it? 

“When someone hears this telltale tinnitus, it may not be dangerous itself, but usually is a symptom of a different health concern that may or may not be,” Lewis says. So don’t ignore it—follow up with an otolaryngologist (aka an ENT, or ear, nose, and throat doctor), she recommends. 

“It's better to just go in and get an evaluation and not be worried about it. ​​Usually it's modifiable,” Lewis says. 

Given the variety of potential causes, you can expect that your doctor will take a patient history and examine you, as well as getting images (such as an MRI or CT), and potentially ordering bloodwork, according to the Weill Cornell Brain and Spine Center. 

This may involve several doctor’s visits or referrals. 

Treatment options 

Your treatment will vary—your health care provider will first want to identify and tackle the underlying cause. If you have anemia, high blood pressure, or an undiagnosed thyroid condition, for instance, treatment for those conditions might help resolve symptoms, Lewis says. 

Surgery may help for a blood vessel disorder, tumor, or ear abnormality, per Penn Medicine.

Sometimes the underlying cause is unknown, or due to an irreversible issue, such as hearing loss. In those cases, the best option is to manage the tinnitus symptoms. Common strategies used to do so include the following, according to Lewis: 

• Sound therapy: White noise machines or hearing aids with noise generators or even a fan can help get you accustomed to the sounds from tinnitus. 
• Cognitive behavioral therapy (CBT): With this type of therapy, you’ll gain tools that’ll help you cope with tinnitus. (Another option is tinnitus retraining therapy, which pairs CBT with masking devices.) 
• Hearing aids for tinnitus: Hearing aids can help a lot with ringing in the ears, especially because most people with tinnitus actually have underlying hearing loss, which can magnify the sound of the tinnitus. Hearing aids allow you to hear the sounds that you want to hear (as opposed to the ringing) and often come with masking features that can help to obscure the sounds of tinnitus. 

Bottom line

If you can hear a pulse-like sensation in one or both ears, get prompt medical help. In most cases, it is treatable.

More: What to know about tinnitus and blood pressure drugs.