Pulsating ringing in the ears? You can fix that – and should.


Tinnitus  is a constant ringing in the ears (pronounced ti-NI-tus according to Webster’s dictionary). Most people deal with it as they age, and most doctors will tell you to learn to live with it.

However, pulsating ringing in the ears is a different story, and can signify a dangerous condition.

If you have this, or know anyone who does, read on.

This type of tinnitus you hear with every heartbeat, in sync. Often the pulsating can be felt in the soles of your feet and palms. The first time this happened to me it was so powerful and loud it woke me from a deep sleep. I was afraid I was having a stroke. As it turns out, this can be a dangerous symptom of an underlying, treatable cause. This type of painless throbbing is not something you should live with. Yet most doctors don’t know what it is. I saw my doctor, had a CT scan, and learned nothing. So, each time it woke me up, I read more, and finally found some good information last night.

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Since this took over a year to find, I’m sharing it here in hopes the keywords might help someone else.

Remember being a kid and hanging upside down on a jungle gym? Your head would eventually throb. That’s what it feels like. No pain, only loud, rhythmic throbbing or whooshing in your ears. The pulsing is often so loud it will wake you from a deep sleep.

Laying at a 45 degree angle helps. Triggers seem to play no part- caffeine, alcohol, salt, exercise, overwork, relaxation, red meat, RedBull, you name it.

If you have this condition, stop at nothing to learn more. Be forewarned you might meet with a variety of physicians until the cause is determined, since attributable conditions cover many health specialties. An ear nose and throat doctor, neurologist, and possibly a surgical neurologist as well as your GP. It is not in your mind, you shouldn’t have to simply live with it – it is a symptom of something potentially serious.

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Image courtesy of US National Library of Medicine and National Institutes of Health (NCBI)

Unlike typical tinnitus, which just causes a high pitched, steady ringing in the ears, Pulsatile Tinnitus can be a  symptom alerting you to a dangerous condition. Ini fact, the US National Library of Medicine and National Institutes of Health (NCBI) says “Pulsatile tinnitus is tinnitus that coincides with the patient’s heartbeat. It constitutes a small portion of all tinnitus, but needs aggressive radiologic evaluation because it is often the first or even sole manifestation of a pathology that, potentially, has serious effects on the nervous system”. Often painless head throbbing is the only symptom of an aneurysm.

Other possible causes of painless head throbbing can be anything from:

  • pseudotumor cerebri (which can often be detected earliest by an eye exam), often caused by obesity
  • intracranial hypertension caused by a tumor
  • hyperthyroidism
  • benign tumors
  • dural sinus stenosis
  • vascular loop
  • jugular bulb abnormality
  • aberrant internal carotid artery
  • intracanalicular acoustic neuroma
  • arteriovenous fistula (AVF)
  • carotid stenosis
  • glomus tumor
  • arteriovenous malformation (AVM)

Here are test which should be run to diagnose pulsatile tinnitus:

  • Eye exam – dialation to rule out pseudotumor
  • Ultrasound
  • CT scan
  • MRI
  • CTA
  • MRA
  • Anigography – the old fashioned way, really, but still listed
  • Blood count to rule out anemia or thyroid problems (such as overactive thyroid which can cause this condition)
  • Less common causes include: Pressure on the malleus, incus and stapes or hammer, anvil and stirrup in the inner ear. Rarely, rhythmic tinnitus can be caused by contraction of certain muscles in the soft palate near the throat, or Patulous Eustachian Tube Syndrome, which varies with breathing.

Since this information was so hard to find, I’m going to share it here:

US National Library of Medicine and National Institutes of Health (NCBI) and Plusatile Tinnitus

Tinnitus.org – a terrific article about Pulsatile Tinnitus

Tinnitus Forum – a message board which covers many symptoms and possible causes to research

Research paper on Pulsatile Tinnitus presented at the American Academy of Otolaryngology-Head Neck Surgery in Chicago, IL in 2008.

Pulsatile Tinnitus and a link to TMJ syndrome (message board)

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