| Pulsatile
Tinnitus
by Barry Keate
Pulsatile
tinnitus is the type of ear noise that is perceived
as a rhythmic pulsing that is often in time with the
heartbeat. It can be experienced as a thumping or
whooshing sound. It is sometimes referred to as
vascular tinnitus because in the majority of
cases, it is related to disturbances in the blood
flow. About 3% of tinnitus patients experience this
type of tinnitus.
 Pulsatile
tinnitus usually originates within the blood vessels
inside the head or neck region when disturbed blood
flow occurs. This results from either increased blood
flow or a narrowing of the opening of the blood vessel,
both of which result in turbulent blood flow that
can be heard in the ears. In this regard, it is totally
different from and independent of continuous tinnitus
which results from damage to the cochlea and/or hearing
nerve.
It
is very possible to have both pulsatile and continuous
tinnitus together. People who have both of these generally
say the pulsatile component is the more bothersome.
It
is important to investigate all instances of pulsatile
tinnitus. In some cases, a serious underlying condition
could exist. In rare cases, this can lead to a catastrophic
event such as stroke. A series of tests, beginning
with an examination of the head and neck by a physician
familiar with the condition, through complex imaging
techniques, is performed. Individuals who find that
the initial imaging results do not reveal abnormalities
should insist on further examination and investigation.
It is possible to misread or miss these trouble spots
that may be tangled in other structures or hidden
by bone or other tissue. Newer imaging techniques,
such as Magnetic Resonance Angiography and Carotid
Artery Ultrasonography, have been employed that help
determine the site of the problem in the majority
of pulsatile tinnitus cases. The cure rates for pulsatile
tinnitus are quite high once the problem area has
been identified.
The
following section describes some of the more common
causes of pulsatile tinnitus and relevant therapies.
1
– Benign Intracranial Hypertension (BIH).
This is a condition where there is increased pressure
of the cerebrospinal fluid that bathes the brain.
The majority of these patients are young females who
are generally overweight. Other symptoms of BIH may
include hearing loss, ear fullness, dizziness, headaches
and visual disturbances. Management of this condition
includes weight loss and administration of a diuretic.
Most patients improve dramatically with weight reduction
alone.
2
– Glomus Tumor. This is a benign vascular
tumor usually located in the ear or just below the
ear at the skull base. It consists of a mass of intertwined
blood vessels. Hearing loss is also a common symptom.
Young patients are usually treated surgically, to
remove the tumor, while older patients may need no
treatment since they are very slow growing.
3
– Atherosclerotic Carotid Artery Disease.
Atherosclerosis is the narrowing of the artery due
to cholesterol build-up on the artery wall. This reduces
the opening resulting in turbulent blood flow that
produces pulsatile tinnitus. This usually occurs in
older patients with a history of hypertension, elevated
cholesterol, diabetes, angina and smoking. The condition
can usually be controlled through medication.
4
– Intracranial Vascular Lesions. These
include aneurism and arteriovenous malformations,
which is an abnormal connection between an artery
and a vein.The blood flows directly from a high pressure
artery to a lower pressure vein without going through
the capillaries. Either aneurism or arteriovenous
malformation can lead to bleeding in the brain and
can be extremely dangerous. Therapies include surgery
and embolizing (closing off) the blood vessels.
5
– Middle Ear Effusion. The middle ear
is normally an air-filled space. If fluid accumulates
in the middle ear due to infection, inflammation or
Eustachian tube dysfunction, pulsatile tinnitus can
result. It is sometime accompanied by decreased hearing,
a feeling of fullness, and may also include pain.
This is most often treated with antibiotics, decongestants,
nasal sprays, etc. or sometimes surgery.
6
– Venous Hum. Patients who are pregnant,
anemic, or have thyroid problems, may develop increased
blood flow through the jugular vein, the largest vein
in the neck. The jugular vein traverses the middle
ear and any turbulent flow in the vein can be heard
in the middle ear as a “hum” which may
or may not fluctuate with the pulse. Correction of
the underlying problem generally results in improvement
or resolution.
7
– Hypertension. There are reports of
patients with high blood pressure whose pulsatile
tinnitus started after they began taking blood pressure
medication. Tinnitus subsided in most after four to
six weeks. For the remainder, a change to another
medication resolved the issue. Others developed tinnitus
from elevated blood pressure and it resolved after
medication reduced the pressure.
8
– Twisted Arteries. Twisted arteries
in the head and neck cause turbulent blood flow leading
to pulsatile tinnitus. It generally does not require
treatment.
These
are the primary causes of pulsatile tinnitus but not
an exhaustive listing.
9
– Other Causes. Other causes can include
Arnold-Chiari malformation where an elongation of
the cerebellum is pushed down through the opening
of the base of the skull, blocking the flow of cerebrospinal
fluid. Muscle spasm in the soft palate can cause a
clicking sound which is rapid (60-200 beats per minute),
repetitive and intermittent. This is associated with
multiple sclerosis, small vessel disease, tumor or
degenerative neurological disorders. The small muscle
attached to the stapes bone in the middle ear can
spasm which produces a crackling or rumbling noise.
There are other, mostly rare, causes of pulsatile
tinnitus as well as those mentioned here.
If
pulsatile tinnitus is caused by turbulent flow in
arteries, pressure applied to the upper neck on the
side of the tinnitus should alter or reduce it. If
it is venous in origin, the Valsalva maneuver may
improve it. This is performed by forcibly exhaling
against closed lips and pinched nose, forcing air
into the middle ear, provided the Eustachian tube
is open. Neither of these is a fool-proof way of identifying
or alleviating the problem but positive results may
lead to a better diagnosis by a physician.
Arches
Tinnitus Relief Formula® is helpful in many cases
of pulsatile tinnitus. The mechanism of action is
Ginkgo biloba extract reduces the viscosity of the
blood and arterial pressure which in turn reduces
the throbbing or pulsing effect. People with pulsatile
tinnitus should always undergo a thorough evaluation
to ensure that serious consequences, such as stroke,
will be prevented.
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