Pulsating Tinnitus...
Q: What causes the sound of your pulse to be heard in your ears?
A: This is known as pulsating, pulsatile or vascular tinnitus. Here is a list of the possible causes of pulsatile tinnitus:
1. Chronic inflammation and/or infection of the middle ear. Chronic inflammation is almost always accompanied by increased blood flow to the inflamed tissue; since this tissue is in the ear, some people are able to hear the increase in blood flow.
2. Eustachian tube dysfunction. For reasons which are unclear to me, ETD can sometimes result in pulsating tinnitus.
3. Middle ear effusion (fluid.) The middle ear is normally an air-filled space. If, due to infection, inflammation or Eustachian tube dysfunction fluid accumulates behind the middle ear, pulsating tinnitus may result. It would be accompanied by decreased hearing and a pressure sensation, and may also be accompanied by pain. Treatment may be medical (with antibiotics, decongestants, nasal steroid sprays and so forth) or surgical.
4. Vascular tumors. Such tumors in the middle ear go by a variety of names, but are most commonly referred to as glomus tumors or paragangliomas. They are benign (not cancerous), but due to their location and vigorous blood supply, they can be very troublesome. Treatment is surgical.
5. Arteriovenous malformations (AVMs.) AVMs are abnormal collections of arteries and veins that sometimes occur within the cranial cavity near the auditory nerve. AVM pulsation against the auditory nerve stimulates the nerve, resulting in a pulsating tinnitus. AVMs can also occur outside of the cranial cavity. AVMs can develop as a result of trauma, but can also occur due to abnormal development in the womb– the individual is born with a small AVM which enlarges later in life. Treatment is usually surgical.
6. Carotid artery-cavernous sinus fistula. A fistula is an abnormal connection; thus, carotid artery-cavernous sinus fistula is an abnormal connection between a very large artery and a very large venous "lake" (not really a "sinus" in the sense of facial sinuses) within the cranial cavity. It is usually the result of severe head trauma. Treatment is nonsurgical, requiring the services of an interventional radiologist.
7. Venous hum. Patients who are pregnant, anemic, or have thyroid problems may develop increased blood flow through the largest vein in the neck, the jugular vein. The jugular vein carries blood from the brain back to the heart; in so doing, it traverses the middle ear. Turbulent blood flow anywhere in the course of the jugular vein can be heard in the middle ear as a "hum" which may or may not fluctuate with the pulse. Correction or resolution of the underlying problem often results in improvement.
There are other, less common, causes of vascular tinnitus, but these are the "biggies." I recommend that you see an ear, nose and throat specialist for a comprehensive evaluation, because (as you can see from this list) many of the possible explanations are NOT trivial!
Pulsatile or pulsating tinnitus
Have the nurse check your BP when you visit today....
