Tinnitus is the experience of hearing a sound when there is no external sound source. It may be described as ringing, buzzing, hissing, humming or whistling. Pulsatile tinnitus is different because the sound is rhythmic and often beats in time with your heartbeat.
Pulsatile tinnitus can affect one or both ears. It should be assessed by a specialist rather than self-managed, particularly if it is new, persistent or only affects one ear. You do not need to assume the cause is serious, but an assessment can identify whether there is an underlying ear, hearing or blood-flow related issue that needs attention.
Common causes of tinnitus and what pulsatile tinnitus may suggest
Tinnitus has many possible causes. Some people notice it alongside hearing loss, exposure to loud noise, ear infections, stress, certain medicines or a build-up of ear wax. It can also develop without a clear single cause.
Non-pulsatile tinnitus is usually a continuous or intermittent sound that does not follow the rhythm of the heartbeat. It may be present in one ear, both ears or seem to come from inside the head.
Pulsatile tinnitus is more often linked to blood flow in the vessels near the ear, neck or base of the skull. In some cases, a person may become more aware of normal blood flow. Changes affecting the ear can also make internal sounds more noticeable, including conductive hearing loss caused by a problem in the outer or middle ear.
Potential causes can include:
- Ear wax, ear infection or middle-ear problems
- Hearing loss
- Changes in blood flow or blood pressure
- Anaemia or an overactive thyroid
- Changes in pressure around the brain
- Less commonly, a blood vessel or structural condition near the ear
This list is not a diagnosis and it is not possible to identify the cause from symptoms alone. Although many causes of tinnitus are not serious, pulsatile tinnitus needs a proper assessment because it is sometimes linked to a treatable underlying condition.
Ear wax can cause a blocked sensation and temporary hearing changes, which may make tinnitus more noticeable. Read more about can ear wax cause hearing loss?
One-sided or pulsatile tinnitus: why it should be checked
Tinnitus in one ear only is called unilateral tinnitus. It is important to arrange a specialist assessment for persistent one-sided tinnitus, especially if it is pulsatile, has changed noticeably or occurs with hearing loss.
National guidance recommends referral for persistent tinnitus that is unilateral or pulsatile. It also recommends an audiological assessment for people with tinnitus.
Seek urgent medical help if tinnitus begins suddenly with sudden hearing loss, weakness in the face or a spinning sensation known as vertigo. Call 999 or attend A&E if these symptoms occur, particularly after a head injury.
You should also seek prompt medical advice if pulsatile tinnitus occurs with:
- New severe headache, vision changes, confusion, weakness or loss of balance
- Significant dizziness or vertigo
- New hearing loss, particularly in one ear
- Ear pain, discharge or bleeding
- Symptoms that are worsening quickly
Dizziness can have several causes, including inner-ear conditions. If you are experiencing dizziness without hearing loss, our guide on can dizziness be ENT related without hearing loss may be helpful. However, tinnitus with significant dizziness still needs medical assessment.
How tinnitus is assessed
An audiology assessment begins with a detailed discussion about what you hear, when it started and whether the sound is constant, intermittent or in time with your pulse. You may be asked whether you have hearing changes, dizziness, headaches, ear symptoms, medical conditions or a history of exposure to loud noise.
The clinician will examine your ears to look for issues such as wax, infection or changes to the eardrum. A hearing test is an important part of assessing tinnitus, even if you have not noticed an obvious hearing problem. Visit our audiology service page for more information.
Further investigations depend on your symptoms and examination findings. For pulsatile tinnitus, a specialist may recommend imaging of the ears, head or neck to investigate possible blood vessel or structural causes. For unilateral non-pulsatile tinnitus, imaging may be considered depending on the wider clinical picture.
You may also need other tests, such as blood tests, if your symptoms suggest a condition such as anaemia or thyroid dysfunction. The aim is to understand whether there is a cause that can be treated and to provide appropriate reassurance where there is not.
Management and treatment options
Tinnitus can sometimes improve when an underlying cause is identified and treated. For example, treatment for ear wax, an ear infection or a hearing problem may reduce tinnitus for some people.
Tinnitus can also settle on its own, particularly when it is linked to a short-term trigger. However, it can persist, so ongoing or troublesome symptoms are worth discussing with a specialist rather than simply waiting for them to pass.
Where hearing loss is present, hearing aids can help some people by making external sounds easier to hear. This can reduce the contrast between tinnitus and the surrounding environment. Some devices also include sound therapy features designed for people with tinnitus.
Other support may include clear education about tinnitus, sound enrichment and psychological therapies such as cognitive behavioural therapy. These approaches do not imply that tinnitus is imagined. They can help reduce the distress, sleep disruption and attention that tinnitus may cause. NICE does not recommend using medication specifically to treat tinnitus itself.
Management should always reflect the cause of your tinnitus and the way it affects your life. Pulsatile and one-sided tinnitus should be assessed before relying on self-management strategies.
Arrange a tinnitus assessment
A new sound in your ear can feel unsettling, particularly when it follows your heartbeat or affects one side only. A hearing test and ear examination can provide a clear starting point, with ENT input or further investigation where needed.
Contact The Forbury Clinic to arrange an audiology or ENT assessment for pulsatile, one-sided or persistent tinnitus.
