Pulsatile Tinnitus: Causes and When to Worry

Most tinnitus is a steady ringing or hiss with no outside source. Pulsatile tinnitus is different: it's a rhythmic whooshing or thumping that beats in time with your heartbeat. That rhythm is a clue, it usually points to blood flow near your ear, and unlike ordinary tinnitus it more often has a findable, sometimes treatable cause. Here's what causes it and, most importantly, when to see a doctor.

Key takeaways

Pulsatile tinnitus is a sound that pulses in sync with your heartbeat, often a whooshing, thumping or swishing, rather than a continuous ring.
It is frequently caused by turbulent or altered blood flow near the ear, from high blood pressure and narrowed arteries to (less commonly) vascular malformations.
Because it can have an identifiable underlying cause, pulsatile tinnitus warrants a proper medical evaluation, not a supplement.
New, one-sided, or worsening pulsatile tinnitus, especially with headaches, vision changes, dizziness or hearing loss, should be checked promptly.

What is pulsatile tinnitus?

Pulsatile tinnitus is the perception of a rhythmic sound that keeps time with your pulse. People describe it as a heartbeat in the ear, a whooshing, a swishing or a low thumping. If you press gently on your neck or hold your breath and the sound changes, that's a strong hint it's pulsatile.

The key difference from common tinnitus is the rhythm. Ordinary (non-pulsatile) tinnitus is usually a continuous ring, buzz or hiss generated somewhere in the hearing pathway. For a broader overview of the everyday kind, see what causes tinnitus and our tinnitus hub.

Pulsatile tinnitus is also more often objective, meaning it corresponds to a real, physical sound inside your body (usually blood moving through a vessel) that a clinician can sometimes even hear with a stethoscope. That physical reality is exactly why it's worth investigating.

Why you hear your heartbeat in your ear

The ear sits close to major blood vessels, the carotid artery, the jugular vein and the sinuses that drain blood from the brain. Normally blood flows smoothly and silently. When flow becomes turbulent, faster, or louder, the sound can transmit to the inner ear and you start to hear each beat.

Two broad things make this happen: your blood itself flowing differently (faster or thinner), or a change in a vessel near the ear (narrowed, widened or abnormally connected).

Common causes of pulsatile tinnitus

Causes range from very ordinary to rare. In rough order from most to least common:

High blood pressure (hypertension). Elevated pressure makes flow more forceful and turbulent, and is one of the most common contributors.
Atherosclerosis, narrowed, hardened arteries. Blood squeezing past a narrowing becomes turbulent and audible.
Anemia. Thinner blood flows faster and more turbulently, which can produce a pulsing sound.
Hyperthyroidism. An overactive thyroid speeds up circulation throughout the body.
Benign (idiopathic) intracranial hypertension, raised pressure of the fluid around the brain, more common in younger adults and often paired with headaches or vision changes.
Venous causes, such as a prominent or high-riding sigmoid sinus or a jugular vein variant.
Vascular malformations, an arteriovenous malformation (AVM) or a dural arteriovenous fistula, where arteries and veins connect abnormally.
Glomus tumors (paraganglioma), usually benign growths of vascular tissue in or near the middle ear.
Acoustic neuroma, a benign tumor on the hearing/balance nerve, occasionally associated with pulsatile symptoms.

Most of these are either harmless or manageable. A few are serious. That mix, and the fact that you can't tell which is which from the sound alone, is the reason for evaluation.

When to see a doctor

Get pulsatile tinnitus evaluated by a doctor

Unlike ordinary ringing tinnitus, pulsatile tinnitus more often has a specific, identifiable cause, sometimes one that is treatable, and occasionally one that is serious. Because of that, it deserves a proper medical assessment rather than self-treatment. See a doctor promptly if your pulsatile tinnitus is new, one-sided, or worsening, or if it comes with headaches, changes in vision, dizziness, or hearing loss. This article is general information, not a diagnosis.

At an appointment, expect questions about your blood pressure, medications and other symptoms, plus a physical exam. To find the cause, an ENT or physician may order imaging , an MRI, MRA (magnetic resonance angiography), CT or ultrasound of the vessels in your head and neck, along with a hearing test and blood work (for example, to check for anemia or thyroid problems).

Don't reach for supplements first

Pulsatile tinnitus is a signal about blood flow, not a nutrient deficiency. There is no supplement that treats an underlying vascular cause, and delaying evaluation to try one can mean a treatable problem goes unaddressed. Get the cause identified first.

How pulsatile tinnitus is treated

The guiding principle is simple: treat the underlying cause, and the sound usually follows. Because pulsatile tinnitus is a symptom rather than a disease, treatment depends entirely on what's found.

High blood pressure → controlling it, often quiets or resolves the sound.
Anemia or an overactive thyroid → treating the blood or thyroid condition.
A narrowed or malformed vessel → may be managed by a specialist, sometimes with a minimally invasive procedure or surgery.
Raised intracranial pressure → addressed by the appropriate specialist.

When a cause is identified and treated, pulsatile tinnitus often improves or disappears, which is a key reason it's worth investigating rather than living with. General tinnitus coping strategies (sound therapy, managing stress and sleep) can still help alongside treatment; you'll find those in our guide to tinnitus treatment.

Supplements are not a treatment for pulsatile tinnitus. If you're exploring options for ordinary, non-pulsatile ringing, and only after a doctor has looked into a pulsing sound, you can read our supplements guide for that separate scenario.

Frequently Asked Questions

Is pulsatile tinnitus dangerous?

Often it's caused by something ordinary like high blood pressure or anemia, but occasionally it points to a more serious vascular problem. Because you can't tell from the sound alone, it should be evaluated by a doctor, especially if it's new, one-sided, or comes with headaches, vision changes, dizziness or hearing loss.

Why can I hear my heartbeat in my ear?

The ear sits close to major blood vessels. When blood flow near the ear becomes turbulent, faster or louder, from raised blood pressure, a narrowed artery, thinner blood, or a vessel abnormality, the pulse can transmit to the inner ear and you hear it beat.

Will supplements cure pulsatile tinnitus?

No. Pulsatile tinnitus reflects blood flow near the ear, not a nutrient deficiency, and no supplement treats an underlying vascular cause. Get the cause identified and treated by a doctor first.

Can pulsatile tinnitus go away?

Frequently, yes, when the underlying cause is found and treated. Controlling high blood pressure, correcting anemia or a thyroid problem, or addressing a vascular issue often quiets or resolves the sound.