You keep hearing that whoosh whoosh in your ear that synchronizes with the beat of your heart: pulsatile tinnitus.

Pulsatile tinnitus has many possible causes including life threatening.

The subjective sound of pulsatile tinnitus can range from very subtle, heard only overnight while a person lies in bed in a perfectly quiet environment, to so noticeable that it impedes quality of life throughout the day.

NOTE: The softness or loudness of pulsatile tinnitus is not indicative of the seriousness of its cause.

As you listen to your pulsatile tinnitus “whoosh” in time with your heartbeat, you may begin wondering if it’s possible that the cause is coming from something wrong with your heart.

“Issues with uncontrolled blood pressure as well as carotid stenosis [narrowing] where there is a blockage in the arteries of the neck can cause pulsatile tinnitus,” says Bethany Doran, MD, a board certified cardiologist and CEO of Enabled Health.

“It happens when there is a high difference in pressures that can be heard in the areas responsible for hearing.

“There are certain conditions like aortic regurgitation that can lead to pulsatile tinnitus that involves the heart, but more generally it is related to high pressures in different arteries.”

Aortic Valve Regurgitation

Though this can cause pulsatile tinnitus, it’s low on the list of possible causes.

Each time the heart pumps out blood, the aortic valve (which has three leaflets) closes to prevent a backflow or regurgitation of blood.

If the closing mechanism isn’t adequate, some blood will reverse flow through the aortic valve.

Aortic valve regurgitation. Laboratoires Servier, CC BY-SA 3.0/

The regurgitation can be mild to severe, with no symptoms to symptoms such as frequent shortness of breath and easy fatigue.

Coronary artery disease, chronic heart failure and arrhythmias do not cause pulsatile tinnitus.

So before you begin rushing to a cardiologist about your pulsatile tinnitus, you should make your first appointment with the head and neck surgery department of your healthcare provider.

You should be referred to an audiologist for an audiogram, since something as simple as earwax buildup can cause pulsatile tinnitus.

If an audiogram can’t find the cause, your head and neck specialist (ear, nose and throat physician) will order some tests as well as listen to your carotid artery through a stethoscope.

I know all this because one overnight after returning from the bathroom, I heard a faint whoosh whoosh in my left ear, synchronized with every beat of my heart.

I knew right away it was the phenomenon known as pulsatile tinnitus, but my mind didn’t go straight to “Could something be wrong with my heart?”

Instead, my mind went straight to an abnormality in the blood vessels in my brain.

This is precisely why, if you have new-onset pulsatile tinnitus, you should not ignore this – no matter how faint it is, even if you barely hear it in the quietest environments.

A cerebral angiogram (MRI) will check for both very serious and less serious causes of your pulsatile tinnitus.

You should also get an ultrasound of your carotid artery, even if the stethoscope exam sounds normal.

Though most causes of pulsatile tinnitus are not life-threatening, you still need these tests to rule out dangerous causes — but also possibly detect other causes.

In my case, the MR angiogram suggested the presence of a jugular bulb diverticulum.

That fancy term simply means that I was born with an out-pouching of part of my jugular vein.

No treatment is necessary unless the PT gets worse and disruptive to my sleep or everyday life, or if the jugular bulb diverticulum begins causing hearing loss or vertigo. In these cases, the condition can be successfully treated.

If a head and neck specialist, and an audiologist, have not found the cause of your pulsatile tinnitus, you may still want to get an exam by a cardiologist to see if you might have aortic valve regurgitation.

If your PT is tolerable, the only treatment will be ongoing monitoring to make sure that the heart condition doesn’t worsen.

Otherwise, medication may be prescribed, and in severe cases, surgery can correct the condition.

Bethany Doran, MD, MPH, is a board certified cardiologist and CEO of Enabled Health, a hybrid in-person and virtual clinic that expands healthcare in rural areas and prevents readmissions for vulnerable patients managing chronic disease. Her work has been supported by grants from the NIH, American Heart Association and New York Academy of Medicine.
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health. 


Top image: Shutterstock/Motortion Films