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Dear Dr. Spector,

My mother has been hearing a faint pulse sound in both her ears for over one week.  She is not experiencing any other symptoms. Should she go to the doctor?

Thank you so much,

Jenn

Cary, North Carolina

Dear Jenn,

This is a problem that I evaluate fairly commonly, and can be quite bothersome. The technical name for this condition is "pulsatile tinnitus." Tinnitus is defined as any persistent noise perceived by the ear, when no external source is present. The pulsatile quality your mother describes differentiates her type from the more common variety that sounds like a continuous tone or buzzing.

In general, noise that coincides with the heartbeat can usually be attributed to a vascular phenomenon. These can often be diagnosed with an imaging study, such as an MRI. The most common diagnosis I find is called a "high riding jugular bulb," and refers to a condition where an otherwise normal blood vessel is positioned closer to the hearing portion of the ear than usual. This condition requires no further treatment, unless it is very loud. Other conditions that involve the abnormal size, shape, blockage or connections of blood vessels also occur, and may require further testing or treatment based on the individual situation. Rarely, abnormal collections of tissue that are rich in blood vessels may form in the head and neck, and usually require removal for cessation of tinnitus.

Other possibilities for persistent rhythmic noises include the twitching of small muscles in the ear or head that are not felt as much as they are heard. A common muscle that does this attaches to one of the small bones in the ear used for sound conduction, and gives a sensation of fluttering in the ear that can be quite annoying. This problem may respond to medications intended to calm overactive muscle contractions, but can eventually be remedied by a quick procedure to clip this muscle if the problem is irritating enough.

One condition that merits special mention usually occurs in overweight, younger females, and develops secondary to an abnormally high pressure in the fluid that surrounds the brain. Known as "benign intracranial hypertension," this malady can lead to more serious problems with vision, headaches and balance, but often responds to medical management.

As you can see, there are many possible etiologies for your mother's pulsatile tinnitus, and I have certainly not covered all of them here. Most of the time, a specific diagnosis can be rendered, although on occasion, no abnormality will be found. I would recommend evaluation by an ENT if the problem does not resolve over a two week period.

Thank you for your question!

Jared E. Spector, MD

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