Understanding Pulsatile Tinnitus: Causes, Symptoms, and Ways to Manage

By  //  July 28, 2023

Tinnitus, a condition that afflicts approximately 10-15% of the general population, can range from a mild annoyance to a debilitating issue.

This subjective auditory experience involves hearing noises in your ears or head, like ringing, buzzing, or hissing, without any sounds in your external environment. 

One specific form, known as pulsatile tinnitus, is particularly unique because the sounds heard aren’t just constant ringing or buzzing but rhythmical noises that often beat in time with the individual’s pulse. Interestingly, unlike regular tinnitus, which is typically only heard by the person experiencing it, pulsatile tinnitus can sometimes be heard by a doctor during an examination, making it an “objective” form of the condition.

This article aims to shed light on the causes, symptoms, and management strategies for pulsatile tinnitus. The noise can be constant or intermittent and can vary in pitch and volume.

Understanding Pulsatile Tinnitus

According to Tinnitus UK, pulsatile tinnitus is observed in roughly 4% of tinnitus sufferers in the United Kingdom. It is also referred to as vascular tinnitus due to its close association with the body’s circulatory system, often arising as a result of changes in blood flow near the ear. In contrast, non-pulsatile tinnitus is typically associated with nerve issues and damage to the auditory system. 

The nature of the sound has been variously described as whooshing, humming, pulsing, thumping, or marching. In fact, what you’re actually hearing is the sound of blood circulating through your body. Moreover, the rhythm of pulsatile tinnitus often matches the heart’s rhythm. This is why the condition can be more noticeable when heart rate and blood flow change, like after exercise or during moments of stress or excitement.

Causes of Pulsatile Tinnitus

The causes of pulsatile tinnitus are varied and can be linked to several different underlying conditions. Many of these are connected to the vascular system, given the condition’s close link to blood flow. Here are some potential causes:

High Blood Pressure

Hypertension (or high blood pressure) may increase blood flow. Factors like stress, alcohol, caffeine, and smoking can temporarily elevate blood pressure and possibly contribute to pulsatile tinnitus.


This condition is characterised by the hardening or narrowing of the arteries due to a build-up of plaque. When it occurs in arteries close to the inner ear, it can cause pulsatile tinnitus. This is because the narrowing can cause an irregular flow of blood, and the hardened artery walls might not dampen the sound of blood flow as effectively.

Turbulent Blood Flow

If blood flow through the veins and arteries becomes turbulent or irregular, it can cause the rhythmic noise of pulsatile tinnitus. While it isn’t typical in blood vessels that are healthy and smooth, changes in the vessel’s shape, such as narrowing, can disrupt smooth blood flow and result in turbulence.

Head and Neck Tumours

Although rare, tumours in the head or neck can press on blood vessels. These tumours might disrupt regular blood flow and create a noise that can be picked up by the auditory system.

Ear Canal Issues

Any abnormal growths, deformities, or infections in the ear canal can cause changes to the structure or function of the ear, affecting how it picks up and interprets sound.

Venous Hum

This condition is often seen in pregnant women and involves hearing the blood flow in the veins and large arteries. It results from increased blood flow and pressure during pregnancy.

Increased Intracranial Pressure

This condition refers to a rise in the pressure of the cerebrospinal fluid that protects the brain and spinal cord. This increased pressure can lead to pulsatile tinnitus, and in some cases, it may signify a more serious condition that requires medical intervention.

Managing Pulsatile Tinnitus

While treating the underlying cause of pulsatile tinnitus is the most effective way to eliminate the symptoms, this isn’t always possible, especially if the exact cause isn’t known. However, even in those cases, there are still various strategies you can employ to manage your symptoms and minimise the impact of tinnitus on your daily life.

Lifestyle Changes

Lowering your intake of stimulants like caffeine and nicotine, which can increase blood pressure, may help alleviate symptoms. Regular physical activity, together with a healthy balanced diet, can also promote better circulation and overall health.

Stress Management

Stress is a common trigger for tinnitus, so trying to manage your stress can help control your symptoms. This can include learning various relaxation techniques, such as deep breathing, yoga, or mindfulness meditation. You might also consider making changes to your work or personal life to reduce overall stress levels.

Sound Therapy

Sound therapy involves using external noises to alter the perception of, or reaction to, tinnitus. This can involve listening to soft music or environmental sounds to help distract from the noise. Some people find relief from white noise machines or apps designed for tinnitus management.

Cognitive Behavioral Therapy (CBT)

CBT is a type of psychological treatment that can be highly effective in managing tinnitus. It doesn’t eliminate the noise but helps you change your perception of it, reducing its impact on your life. This is where Oto can be particularly useful.

Oto is a dedicated tinnitus management tool designed with input from leading audiologists. It offers a range of services, including CBT-based therapeutic exercises designed to help tinnitus sufferers better understand and manage their condition. By integrating the practices learned through Oto’s digital program into your daily routine, you can foster a healthier relationship with your tinnitus and reduce its interference in your everyday life.

Hearing Aids

In case tinnitus is associated with hearing loss, then wearing a hearing aid to amplify other sounds can sometimes help to mask the tinnitus noise. What’s more, some hearing aids also come with built-in sound generators for tinnitus therapy.

Medical Treatment

Depending on the underlying cause of your pulsatile tinnitus, certain medications or procedures may help. For example, if high blood pressure is causing your tinnitus, antihypertensive medications may alleviate your symptoms. Always seek the advice of your physician or other healthcare professional prior to starting any new treatment regimen.


Pulsatile tinnitus, while unique, is just as manageable as other forms of the condition. Understanding the causes and potential treatments is the first step towards effective management. If you or someone you know is experiencing symptoms of pulsatile tinnitus, seek medical advice to diagnose any underlying conditions and start on a path towards effective treatment. Remember, help is available, and with the right strategies, living with tinnitus can become much more manageable.