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Pulsatile Tinnitus

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Some cases of pulsatile tinnitus are caused by a narrowing of one of the large veins in the brain (red circles). The narrowing, or stenosis, disrupts the flow of blood and can lead to the whooshing sound or other noises of pulsatile tinnitus.

Tinnitus, which is the perception of sound when no external sound is present, is a complex symptom rather than a syndrome or disease. It can present itself as many possible sounds, including whooshing, ringing, whistling, buzzing, or clicking. These abnormal noises can be perceived in one or both ears, and can occur intermittently or constantly. It is estimated that tinnitus affects about 25 percent of the general population.

Tinnitus has many variants and can be categorized by its level of audibility, rhythm, and etiology. Tinnitus that can be heard by a physician is termed objective tinnitus. Subjective tinnitus is audible only to the patient. Tinnitus can also be categorized by its rhythm, separating it into “continuous” and “pulsatile” tinnitus.

Continuous tinnitus is characterized as a constant “ringing in the ear” and is typically the result of problems with the ear or auditory pathways. Pulsatile tinnitus, on the other hand, is a condition characterized by rhythmic whooshing or thumping sounds within the ear that are in synch with a patient’s heartbeat or pulse. Pulsatile tinnitus affects only a small percentage of the population. Pulsatile tinnitus is mostly reported as an annoying rather than severe symptom; a subset of patients, however, experience it to a debilitating degree. Furthermore, pulsatile tinnitus may be the only presenting symptom of an underlying serious condition such as dural arteriovenous fistula, intracranial arteriovenous malformation, venous sinus stenosis, idiopathic intracranial hypertension (IIH, or pseudotumor cerebri), arteriosclerosis, or vascular tumor such as paragangioma. Any of these conditions may be dangerous if left undiagnosed and untreated.

Pulsatile tinnitus rarely goes away by itself, and it can be difficult to endure for some patients. The sounds can become so intense and frequent as to become incapacitating; the sound may interfere with work, cause difficulty sleeping or concentrating, increase stress, and create feelings of depression or anxiety. Fortunately, pulsatile tinnitus can often be successfully treated and cured once its underlying cause is identified.

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Reviewed by: Srikanth Boddu, MD, MSc
Last reviewed/updated: August 2020
Illustration by Thom Graves Creative, CMI

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