Tinnitus is a condition in which a person perceives sound when there should be none perceived. An example would be a ringing in the ears when the environment is devoid of sound.
Pulsatile tinnitus is one form of tinnitus. Normal tinnitus can be caused by several different factors whereas pulsatile tinnitus is usually caused by disturbances in blood circulation near ear origins.
This type of condition is called as “pulsatile tinnitus” since the perceived noise goes often along with pulse. The noise is often whooshing, clicking, or some other sound of that type and typically caused by increased blood flow or some type of disturbance in the flow.
This phenomenon can be explained with an analogy to flow turbulence in a garden hose. When water gushes out of a garden hose without any obstruction, the water flows smoothly and with little noise. However, when a thumb is put in front of the exit of the gardening hose, the water flows faster and emits noise.
The same principle is true in pulsatile tinnitus. This is the cause of the noise; the rhythmic noise comes from the heart beating and the pulse being generated from blood pumping throughout the body.
The most important step before pulsatile tinnitus treatment is diagnosis of the source. Sometimes the source is benign like a venous hum. More typically, the cause is due to atherosclerosis of an artery near the ear, such as the carotid artery. The bruit produced is loud enough to be heard by the nearby ear.
More serious causes are rarer, but cannot be ruled out. Such causes include carotid artery dissection, carotid artery aneurysm, idiopathic intracranial hypertension, and pulsatile paraganglioma (a type of tumor) inside the inner ear.
Working up the cause includes a good physical exam, blood tests, and imaging. While tinnitus treatment is based on the symptoms, pulsatile tinnitus treatment is based on the source.
In mild venous hum cases there is no treatments required since the sound will usually disappear on its own.
For atherosclerotic causes, the treatment depends on both the severity of artery occlusion and the patient’s wishes. For mild to moderate cases, watchful waiting is recommended along with taking an aspirin to prevent worsening of the blockage or any other acute event.
For more severe cases, surgery is required. Options include stents, plaque and clot removal, and bypass. Typically for carotid arteries, plaque and clot removal is required to keep blood flow to the brain patent.
Carotid artery dissection is an emergency, and requires immediate surgical repair. Aneurysms may be watched, or operated upon based on the imaging. A pulsatile paraganglioma or other tumor causing increased blood flow to the ear may have to be operated on by a skilled otolaryngologist.