December 10, 2025
What is Pulsatile Tinnitus?
Article Navigation: Quick Access to Sections
Hearing your heartbeat in your ear is called pulsatile tinnitus. This guide explains what it is, why it happens, the red flags that need urgent care, and practical steps to diagnose and manage it—so you can feel informed and in control.
You’re lying in bed and the room is quiet, but your ear is anything but. A whooshing sound keeps time with your pulse—as if a tiny drum is beating inside your head. It’s unsettling, distracting, and hard to ignore.
If this sounds familiar, you may be dealing with pulsatile tinnitus, a specific form of tinnitus where the sound syncs with your heartbeat. You’ll learn what causes it, how doctors evaluate it, which symptoms need prompt attention, and what you can do today to get relief. For a refresher on the broader condition, understanding the basics of tinnitus can help you put pulsatile tinnitus in context.
What Is Pulsatile Tinnitus?
Pulsatile tinnitus is the perception of a rhythmic "whoosh," "thump," or "heartbeat" in the ear without an external sound source. Unlike common, steady ringing or buzzing, pulsatile tinnitus is typically synchronous with your pulse. It's less common—often estimated in 4–10% of tinnitus presentations—but it matters because it can be linked to identifiable, sometimes treatable, causes.
Understanding pulsatile tinnitus starts with two important distinctions. Most tinnitus is "subjective," meaning only you can hear it. But some pulsatile cases are "objective"—a clinician can actually hear the sound with a stethoscope placed over your ear or skull. This objective quality often signals a physical source that can be identified and sometimes treated.
The second distinction involves origins. Pulsatile tinnitus frequently relates to blood flow—arterial or venous—near the ear. When vessels narrow, kink, or experience pressure changes, turbulent flow can create audible sound. However, non-vascular causes like middle ear fluid can also produce rhythmic sounds that sync with your heartbeat.
Why You Hear Your Heartbeat: The Science
Your ears sit next to an intricate network of arteries and veins. When blood flow becomes turbulent—think of water rushing through a narrowed pipe—it can generate sound. That sound travels through bone and soft tissues to your middle ear where it's amplified, creating the rhythmic whoosh you hear.
This amplification happens most clearly when a vessel narrows or kinks (like carotid artery disease or venous sinus stenosis), when pressure dynamics shift (such as idiopathic intracranial hypertension), or when sound conduction is enhanced by a thin or dehiscent bone plate over a blood vessel. Sometimes, fluid in the middle ear can also amplify these vascular sounds.
Here’s how pulsatile tinnitus compares to more typical (non-pulsatile) tinnitus:
| Feature | Non-pulsatile tinnitus | Pulsatile tinnitus |
|---|---|---|
| Sound quality | Constant ringing, buzzing, hissing | Rhythmic whooshing or thumping in time with heartbeat |
| Common causes | Hearing loss, noise exposure, medications | Vascular flow changes, middle ear fluid, tumors, pressure disorders |
| Urgency | Usually non-urgent; exceptions apply | Often merits medical evaluation; some causes need prompt care |
| Common tests | Hearing test, tympanometry | Hearing test plus targeted imaging (CTA/MRA/MRV), sometimes ultrasound |
| Treatability | Symptom-focused | Often cause-directed treatment is possible |
Because anxiety can amplify sound perception, it helps to learn strategies from our guide on tinnitus and stress while you seek a diagnosis.
Common Causes of Pulsatile Tinnitus
Understanding what might be causing your pulsatile tinnitus helps guide evaluation and treatment. Not every cause is dangerous, but many deserve medical attention. The causes typically fall into four categories.
Vascular causes involve changes in blood flow near your ear. Atherosclerotic narrowing of the carotid artery can create turbulent flow that you hear as a whoosh. Dural arteriovenous fistulas (dAVF) or arteriovenous malformations (AVM) create abnormal connections between arteries and veins. Venous sinus stenosis or a dominant jugular bulb can produce a turbulent "venous hum." Carotid dissection—a tearing of the artery wall—often comes on suddenly with neck pain and requires urgent care. High blood pressure and elevated cardiac output states can also amplify vascular sounds.
Pressure and structural issues can enhance sound transmission. Idiopathic intracranial hypertension (IIH), more common in younger women, increases pressure around the brain and often accompanies headaches and visual symptoms. Superior semicircular canal dehiscence or sigmoid sinus dehiscence occurs when bone thins or breaks, allowing sound to travel more easily from blood vessels to your inner ear.
Middle ear conditions like fluid buildup (middle ear effusion) or Eustachian tube dysfunction can amplify vascular sounds. Glomus tumors, which are vascular tumors in the middle ear or jugular bulb, can also create pulsatile tinnitus.
Systemic factors like anemia, thyroid disorders, pregnancy, and fever or infection can increase blood flow or change its viscosity, making vascular sounds more audible. Certain medications or stimulants may influence blood pressure or perception, though the evidence varies.
If you’re curious about broader tinnitus causes and how they differ, skim the common causes of tinnitus overview.
When to Seek Medical Help (and Red Flags)
Knowing when to seek help can make all the difference. Call your healthcare provider if your pulsatile tinnitus starts suddenly, affects only one side, or follows head or neck trauma. Pay attention if the sound changes when you turn your head or apply gentle neck pressure, or if you can hear it across your entire head rather than just one ear.
Some symptoms signal more urgent concerns. If pulsatile tinnitus comes with headaches, visual disturbances, or transient vision loss, it might indicate idiopathic intracranial hypertension (IIH). Neurological symptoms like weakness, facial droop, or slurred speech require immediate attention. Severe neck pain alongside pulsatile tinnitus could suggest carotid dissection—a medical emergency. Ear fullness, drainage, or hearing loss also warrant prompt evaluation.
Urgent evaluation is wise if any of these red flags appear. If you notice sudden hearing changes, time matters—learn what clinicians do in How Audiologists Diagnose and Treat Tinnitus and seek care promptly.
How Pulsatile Tinnitus Is Diagnosed
Your evaluation will be tailored to your specific symptoms. Not everyone needs every test—clinicians customize the workup based on what they find during your exam.
The process typically begins with a thorough history and physical exam. Your doctor will ask you to characterize the sound: Does it match your pulse? Is it one-sided or both? How long has it been happening? What makes it better or worse? They'll check whether turning your head, lying down, or gentle neck pressure changes the sound. (Important: Don't press hard on your neck—leave formal testing to professionals.) They'll also check your blood pressure and review your medications, medical history, and recent illnesses.
Next comes ear and hearing evaluation. An otoscopy allows your doctor to look for middle ear fluid or visible vascular tumors behind the eardrum. Audiometry and tympanometry assess your hearing and middle ear pressure, helping identify any conductive issues that might amplify vascular sounds.
If vascular causes are suspected, targeted imaging may follow. CT or CTA (computed tomography with angiography) provides detailed views of bone and arteries. MRI, MRA, or MRV (magnetic resonance imaging with angiography or venography) evaluates soft tissues and veins. When arterial narrowing is suspected, a carotid ultrasound can assess blood flow.
Laboratory tests might include a complete blood count (CBC) to check for anemia, a thyroid panel, and other labs guided by your history. Depending on what's found, you may be referred to specialists—ENT/neurotology, neurology, or interventional radiology—who collaborate to pinpoint the cause.
If you’re navigating this process for the first time, our primer on managing tinnitus can help you track symptoms and questions between appointments.
Treatment: Fix the Cause vs. Ease the Sound
There's no one-size-fits-all treatment—your plan depends on the root cause. The good news: many causes are treatable, and addressing the underlying issue can sometimes resolve or greatly reduce the sound.
Cause-directed treatments target the specific source of your pulsatile tinnitus. If hypertension or atherosclerosis is the culprit, optimizing blood pressure, cholesterol, and lifestyle changes can help. Anemia responds to treating iron deficiency or underlying causes. Thyroid disorders improve with hormonal correction. For idiopathic intracranial hypertension (IIH), weight management, medications like acetazolamide, and sometimes procedures to lower pressure can help. Venous sinus stenosis may be treated with endovascular stenting in selected cases. Dural arteriovenous fistulas or arteriovenous malformations require embolization or surgery by specialized teams. Glomus tumors may need surgical removal or radiotherapy. Middle ear effusion can be managed with medical therapy or a myringotomy procedure when needed.
Symptom management supports your quality of life while the cause is being addressed. Sound therapy reduces the contrast and eases the "edge" of the whoosh. Learn about effective masking in The Power of White Noise and try White Noise, Nature Sounds, or Water Sounds at comfortable volumes. Cognitive Behavioral Therapy (CBT) can reduce distress and improve coping—explore Cognitive Behavioral Therapy and Tinnitus to learn more. When appropriate, noise-canceling headphones can lower environmental load, but always avoid unsafe volumes. Don't underestimate lifestyle factors: sleep quality, stress management, and cardiovascular fitness all influence perception and triggers.
Always discuss procedures, medications, and supplements with your clinician first. There's no guaranteed cure for tinnitus itself, but treating a specific pulsatile cause can sometimes resolve or greatly reduce the sound.
Practical Daily Tips While You Await Evaluation
Small changes can make the heartbeat sound less intrusive, especially at night. These strategies won't cure pulsatile tinnitus, but they can help you manage it while you work with your healthcare team.
Create a sound cushion to reduce the contrast in quiet rooms. Use gentle white noise or soft evening sounds at low volume—just enough to blend with the whoosh without overwhelming your hearing. See our primer on The Power of White Noise for safe practices that protect your hearing while providing relief.
Sleep smarter by elevating your head slightly and choosing the side that's more comfortable. Position can affect venous flow, which may change how loud the sound feels. For more strategies, browse Tinnitus and Sleep. Follow a consistent wind-down routine and minimize caffeine late in the day to support better sleep quality.
Tame the stress cycle because stress ramps up attention and arousal, which can intensify perception. The tips in Tinnitus and Anxiety: Staying Mentally Strong pair well with CBT skills. Try short, daily mindfulness sessions—even 5 minutes helps. If you prefer guided tools, check Apps That Help Tinnitus or try features in our app.
Track patterns by noting what changes the sound: posture, exercise, sleep, hormones, or salt intake. Keep a 1–2 week log and share it with your clinician—these patterns can provide valuable clues about triggers and potential causes.
Support cardiovascular health through balanced exercise, blood pressure control, and proper hydration. These practices can calm contributors like elevated pressure and heart rate variability. While the evidence isn't absolute, these habits are good for your overall health and may help reduce the intensity of pulsatile tinnitus.
Conclusion: From Worry to a Clear Plan
Pulsatile tinnitus is the sound of your pulse in your ear, and it often points to an identifiable cause. That’s why a thoughtful medical evaluation matters. Many causes are manageable—and some are correctable—once you and your clinician pinpoint the source.
While you pursue answers, you can ease day‑to‑day distress with sound therapy, CBT‑based coping, and steady sleep routines. Start by logging your symptoms, using gentle white noise at night, and scheduling a medical evaluation; if you’re new to the care pathway, How Audiologists Diagnose and Treat Tinnitus outlines what to expect. You’re not alone, and with a clear plan, that internal drumbeat doesn’t have to run the show.