Tinnitus that pulses in rhythm: Understanding the causes, signs, and possible remedies
Pulsatile tinnitus, a rhythmical noise that beats at the same rate as the heart, is a type of tinnitus that is different from other forms as it has a physical source [1]. This condition is caused by changes in blood flow near the ear, which can be due to various factors such as atherosclerosis, increased blood flow, localized increased flow, or turbulent blood flow [1].
Vascular abnormalities are one of the common causes of pulsatile tinnitus. These can include conditions like venous hum, high riding or dehiscent jugular bulb, sigmoid sinus diverticulum, cervical atherosclerosis, carotid artery aneurysm or dissection, and dural arteriovenous fistulas or malformations [1].
Tumors, particularly paragangliomas and hemangiomas affecting the facial nerve or cavernous areas, can also lead to pulsatile tinnitus [1]. Middle ear disorders, inner ear disorders, and other conditions like idiopathic intracranial hypertension and vasculitis can also contribute to this condition [1].
In cases where pulsatile tinnitus is suspected, a thorough medical evaluation is crucial. This may involve examining the inside and outside of the ear, checking for treatable problems like infections or excess earwax, and performing additional tests like MRI or ultrasound scans to study blood vessels and check the pressure inside the head [1]. Specialists may also examine the eyes, head, and neck, and perform a hearing test [1].
Treatment for pulsatile tinnitus depends on addressing the underlying cause and alleviating symptoms. Medical and surgical treatment may involve correcting vascular lesions, surgical removal of tumors, and treating underlying conditions like atherosclerosis or vasculitis [4]. Medications such as benzodiazepines, carbamazepine, and steroids may provide relief in some cases [2].
Behavioral therapies, including tinnitus retraining therapy (TRT), cognitive-behavioral therapy (CBT), and biofeedback, can help patients cope with the distress caused by tinnitus [2]. Masking devices, electronic devices or hearing aids that produce white noise or environmental sounds, can make tinnitus less noticeable [4]. The FDA-approved Lenire device, which uses combined audio and tongue stimulation, can be used at home to reduce tinnitus symptoms [2].
Untreated pulsatile tinnitus can negatively impact a person's quality of life. However, many self-management approaches can help reduce symptoms. These include sound therapy, relaxation, and cognitive behavioral therapy [5]. It is essential to consult a healthcare professional for an accurate diagnosis and appropriate treatment.
References: [1] American Tinnitus Association. (n.d.). Pulsatile Tinnitus. Retrieved from https://www.ata.org/understanding-tinnitus/types-tinnitus/pulsatile-tinnitus [2] National Institute on Deafness and Other Communication Disorders. (n.d.). Tinnitus. Retrieved from https://www.nidcd.nih.gov/health/tinnitus [3] National Institute on Deafness and Other Communication Disorders. (n.d.). Tinnitus: Causes. Retrieved from https://www.nidcd.nih.gov/health/tinnitus/causes [4] American Academy of Otolaryngology—Head and Neck Surgery Foundation. (2019). AAO-HNSF Position Statement: Management of Tinnitus. Retrieved from https://www.entnet.org/content/aao-hnsf-position-statement-management-tinnitus
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