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Pulsatile Tinnitus – What Causes This Tinnitus Type?
Pulsatile tinnitus is a rhythmic sound that beats in time with your pulse. There may be single or multiple rhythmic beats that can be heard as a low pitch thumping or booming sound or as a high pitch clicking sound.
Although pulsatile tinnitus is not a common form of tinnitus, it has some well-known causes, including high blood pressure, heart murmurs, glomus (globe-shaped) tumors, Eustachian tube disorders, or malformations of a blood vessel or artery. Most of the time, pulsatile tinnitus can be treated effectively.
Pulsatile tinnitus is caused by changes in blood flow in the large arteries and veins of the neck, base of the skull, or small blood vessels in the inner ear.
Blood flow can be affected by a variety of factors, including:
Generalized increased blood flow throughout the body that occurs during strenuous exercise or can be caused by severe anemia.
Localized blood flow can increase when the blood vessel is narrower than it should be. This requires adjacent blood vessels to carry the extra blood. Excess current creates noise and can result in pulsatile tinnitus.
Turbulent blood flow occurs when the inside of a blood vessel narrows (hardening of the arteries) and blood flow becomes irregular rather than smooth.
When pulsatile tinnitus is suspected, additional tests to study blood vessels and check intracranial pressure may be necessary. Patients with pulsatile tinnitus usually undergo some form of medical imaging, such as ultrasound, CT scanning, magnetic resonance scanning (MRI), magnetic resonance angiography (MRA), or angiography.
Possible causes of pulsatile tinnitus include:
- Arteriovenous malformations (AVMs) – An abnormal group of arteries and veins that arise in the cranial cavity near the auditory nerve.
- Carotid artery-cavernous sinus fistula – abnormal connection between a large artery and venous bridge in the cranial cavity; Usually the result of a severe head injury.
- Acute inflammation and/or infection of the middle ear. Chronic inflammation is almost always accompanied by increased blood flow to the inflamed tissue. Because this tissue is in the ear, some people hear increased blood flow.
- Middle ear fluid. The middle ear is usually an air-filled space. If there is an infection or inflammation, or if there is Eustachian tube dysfunction, fluid will accumulate behind the middle ear, resulting in pulsatile tinnitus.
- Vascular tumors in the middle ear – commonly known as glomus (globe-shaped) tumors or paragangliomas. Surgery is required to correct this problem.
- Pulsatile tinnitus also occurs when there is narrowing or partial blockage of these arteries due to atheroma, which is a fatty deposit in the inner lining of the artery, which can obstruct blood flow and is caused by high levels of cholesterol in the body.
Can pulsatile tinnitus be treated?
Treatment of pulsatile tinnitus is related to its specific cause. For example, high blood pressure can be treated with medication and blocked or narrowed arteries can be repaired with surgery.
Lowering blood cholesterol levels will also help reduce the level of pulsatile tinnitus.
Treatment of pulsatile tinnitus usually involves a multidisciplinary approach and includes various symptom management methods. Most patients with pulsatile tinnitus are treated with standard methods of tinnitus treatment, including medication, alternative therapies, biofeedback, and sound and/or relaxation therapy.
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