Pulsatile tinnitus: causes, treatment and when to see a doctor

Tinnitus UK says that if there is a physical reason for the pulsatile tinnitus, treating the underlying cause can help. What treatment is needed therefore depends on what is found: for example, treating anaemia or an overactive thyroid, or specialist care for a vascular or ear condition.

Where no treatable cause is found, the NHS tinnitus page describes approaches for tinnitus in general. These include cognitive behavioural therapy (CBT), usually digital CBT first, tinnitus counselling and tinnitus retraining therapy, which may be available on the NHS for severe or persistent tinnitus. The NHS says it is unclear if tinnitus retraining therapy works for everyone and that it is widely available privately. Hearing aids may be recommended if you have hearing loss.

Tinnitus UK explains that it is caused by a change in blood flow in the vessels near the ear, or by a change in awareness of that flow. These vessels are in the large arteries and veins of the neck and base of the skull, or the smaller ones in the ear. It stresses the list of causes is not exhaustive and that anyone with pulsatile tinnitus should be assessed by a doctor.

Tinnitus UK lists pregnancy among the causes of generalised increased blood flow, because blood that flows quickly makes more noise than blood that flows slowly. Severe anaemia is another cause of the same type, and anaemia can happen in pregnancy.

The NHS says to ask for an urgent GP appointment for any tinnitus that beats in time with your pulse. If you are pregnant and notice it, mention it to your midwife or GP so a blood count and, if needed, thyroid tests can be arranged, as Tinnitus UK lists these among investigations.

Tinnitus UK says the noise is rhythmical and usually has the same beat as the heart. The NHS lists throbbing and whooshing among the sounds people describe with tinnitus, which may be in one or both ears, or in the head, and may come and go or be constant.

Tinnitus UK notes that other rhythmical tinnitus that is not in time with the pulse exists, for example due to rhythmical contraction of small muscles in the middle ear (myoclonus) or patulous Eustachian tube syndrome, where the sound varies with breathing, and that people with these should also consult a doctor.

Tinnitus UK says the doctor will take a detailed history and examine the ears and the blood vessels of the neck, possibly using a stethoscope to listen to the neck and skull. If the doctor can hear the pulsing through the stethoscope it is called objective pulsatile tinnitus; if not, subjective. A hearing test is common, and people with pulsatile tinnitus will generally be referred for some form of imaging.

• MRI scan of the head and inner ears.

• MR angiography to show irregularities or narrowing of arteries or veins.

• CT scan, and CT angiography with contrast injection.

• Angiography, using contrast and X-rays.

• Doppler ultrasound of the blood flow in the neck.

• Blood tests, for example a full blood count to rule out anaemia and thyroid function tests.

• Opinions from ophthalmologists or neurologists if benign intracranial hypertension is suspected.

The NHS says to ask for an urgent GP appointment if you have tinnitus that beats in time with your pulse. It says to see a GP if tinnitus is regular or constant, getting worse or bothering you, for example affecting sleep or concentration.

The NHS says to go to A&E or call 999 if you have tinnitus after a head injury, or tinnitus with sudden hearing loss, weakness in the muscles of the face or a spinning sensation (vertigo).

The NHS lists things that can help with tinnitus. Try to relax, for example with deep breathing or yoga, improve sleep with a bedtime routine and less caffeine, avoid things that make it worse such as stress or loud background noise, and join a support group. It says not to aim for total silence, because soft music or sounds may distract you, and not to focus on it.

On the NHS, a GP will examine the ears and may arrange blood tests and refer to ENT or audiology for hearing tests and imaging. Specialist vascular or neurology review follows if a vessel or pressure problem is suspected.

Private ENT consultations and MRI or CT scans are also available, usually self-paid or insured. Whichever route, pulsatile tinnitus should be assessed, because a cause is more likely to be found than for other forms of tinnitus.