Pulsatile Tinnitus: 10 Reasons You Hear a Pulse in Your Ear
If you’ve ever been to a concert or sat too close to a loudspeaker, you’ve likely experienced ringing in your ears afterward.
But if you often hear a sound that’s in sync with your heartbeat or a pounding pulse in your ear, you might be dealing with pulsatile tinnitus, a condition that causes rhythmic thumping, whooshing, or throbbing in one or both ears, according to Penn Medicine.
Don’t panic. Pulsatile tinnitus is often temporary and harmless, says Oliver Adunka, MD, director of the division of otology/neurotology and cranial base surgery at The Ohio State University Wexner Medical Center.
Although it usually isn’t bad to hear your heartbeat in your ears, it can also be the first sign of an underlying (sometimes serious) health issue, Dr. Adunka says. To be safe, you should always seek medical attention and a proper evaluation if you experience a persistent pulse in your ear.
Here are 10 causes of pulsatile tinnitus.
Anyone who’s ever pushed through a strenuous sweat session has probably heard their heart pump in their ears after the workout. This is very normal, Adunka says.
When you exercise vigorously, your cardiac output increases, briefly boosting how much blood is flowing through your vessels, including those near your ears, he explains. And this temporary rise in blood flow can sometimes produce a pounding sound in your ears.
With anemia, your blood composition changes — your red blood cell count is low — which can trigger turbulent blood flow in your veins, Adunka says. And this turbulent flow can generate the thumping noise in your ears.
Here’s why: Behind your ears, there are big blood vessels that transport blood from your brain back to your heart. Usually, you can’t hear those vessels, but if the blood flowing through them is forceful (as is the case with people with anemia), you can, Adunka says.
He uses the analogy of a river to illustrate the point: If the water is running smoothly, it’s mostly silent. However, if you have white water, it’s very loud. Due to the altered blood composition, people with anemia essentially have “white water” coursing through their veins.
Similarly, thyroid conditions can alter the composition of your blood, Adunka says. And this can sometimes cause fluctuations with blood pressure that can affect the venous return to the heart and produce pulsations in your ears, he explains.
People who have fluid in their middle ear, which may or may not be related to an ear infection, often hear their heartbeat. That’s because the blood vessels around the ear will usually pulsate the fluid (which temporarily replaces air) in the middle ear, Adunka says.
If you have high blood pressure, it can cause the blood to flow through your veins and arteries with more force, according to Harvard Health Publishing. (Your blood pressure is high when the top number is 120 or higher and/or the bottom number is over 80, says the American Heart Association.)
And when there’s turbulent blood flow through the carotid artery, this can produce a pulsating noise in your ears.
In atherosclerosis, a plaque of fats, cholesterol, and other substances builds up inside your arteries, which can become narrowed.
Like with high blood pressure, this causes the blood flowing throughout your body, including in your ears, neck, or head, to become more forceful, causing you to hear the rhythmic thumping in your ears, according to Penn Medicine.
During pregnancy, you experience an increase in both blood volume and blood pressure, which can affect the major blood vessels surrounding the inner ear, according to the British Tinnitus Association (BTA).
What’s more, when you’re expecting, you naturally retain more salt and water that can cause localized inflammation and impact the tissues near the ear. And hormonal fluctuations can change the nerve cell activity of the inner ear, triggering or increasing pulsatile tinnitus, according to the BTA.
Luckily, the pounding in your ears usually resolves or reduces after you give birth. However, University of Utah Health warns that it can be a sign of dangerously high blood pressure, so you should bring it up to your doctor.
Idiopathic intracranial hypertension (IIH) — a condition that causes pressure in your brain — can cause a hammering heartbeat noise in your ears as well, Adunka says.
Other symptoms of IIH include the following, according to Cedars-Sinai:
Paragangliomas — rare, neuroendocrine tumors in the head and neck that are typically benign — almost always have pulsatile tinnitus as a symptom, Adunka says.
Depending on the tumor’s location, paragangliomas can also cause these symptoms, according to the Stanford Ear Institute:
A blood vessel disorder such as an arteriovenous malformation (AVM) can also be the basis of a beating sound in your ears, Adunka says.
With an AVM, arteries and veins become intertwined and tangled (the high-pressure system in the arteries gains access to the low-pressure system in the veins), Adunka explains. And it’s this abnormal connection between blood vessels that causes the noise.
Other AVM symptoms include, according to Johns Hopkins Medicine:
If undetected, an AVM can lead to serious complications, such as bleeding in your brain, Adunka says.
This has to do with the sigmoid sinus, a large blood vessel behind your ear that leaves your brain and drains into your jugular vein, Adunka says.
“If you turn your head or hold it in a certain way, you basically change the position of the sigmoid sinus and how much blood is going through that vessel behind your ear,” he says.
For instance, when you push into your neck (right next to your larynx), you can make the vessel smaller. For some people, this can decrease (or increase) the thumping in their ears, Adunka says.
Likewise, when you lie down, especially on your side, you can affect the position of the sigmoid sinus, and this can result in a louder pounding noise.
Plus, you’re more likely to hear your heartbeat in your ears at bedtime because it’s quiet and there are fewer distractions, Adunka adds.
An incessant thumping in your ears is incredibly irritating and can interfere with your daily life, making it difficult to concentrate or sleep. “People shouldn’t have to live with it,” Adunka says.
While most cases of pulsatile tinnitus are temporary, you should seek medical help if the pounding in your ear persists, especially because it can be a sign of a more serious underlying health issue.
Adunka recommends seeing a neurotologist — a highly specialized ear, nose, and throat doctor — who has more experience than a general practitioner or family physician when it comes to inner ear concerns.
Once you receive a proper medical evaluation and diagnosis, you can treat the problem at the source and put a stop to the pulsing in your ears.
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