What Causes the Sound of Your Pulse in Your Ears?

What causes the sound of your pulse to be heard in your ears?


A pulse in your ear is known as "pulsating" or "vascular" tinnitus. (Tinnitus generally means ringing or roaring in the ears.) Here is a list of the possible causes of pulsating tinnitus:

  • Chronic inflammation or infection of the middle ear. Chronic inflammation in any part of the body is almost always accompanied by increased blood flow to the inflamed tissue. When this tissue is in the ear, some people are able to hear the increase in blood flow.
  • Eustachian-tube dysfunction. The eustachian tubes connect the middle ears to the upper throat. They open to ventilate the middle ears and equalize internal and external air pressure. For reasons that are unclear, inability of the tubes to open properly can sometimes result in pulsating tinnitus.
  • Middle-ear effusion (fluid). The middle ear is normally an air-filled space. If fluid accumulates behind the eardrum (due to infection, inflammation or eustachian-tube dysfunction), pulsating tinnitus may result. That symptom would be accompanied by decreased hearing, a sensation of pressure in the ear and in some cases, pain. It can be treated with medication (antibiotics, decongestants, nasal steroid sprays and so forth) or surgery.
  • Vascular tumors. Such tumors in the middle ear go by a variety of names, but are most commonly referred to as "glomus" tumors or "paragangliomas." They are benign (not cancerous), but due to their location and vigorous blood supply, they can be very troublesome. Treatment requires surgery.
  • Arteriovenous malformations (AVMs). AVMs are abnormal collections of arteries and veins. They sometimes occur within the cranial cavity near the auditory nerve. An AVM pulsating against the auditory nerve stimulates the nerve, resulting in a pulsating tinnitus. AVMs can occur as a result of trauma or due to abnormal development in the womb. For example, a person may be born with a small AVM that enlarges later in life. Treatment is usually surgical.
  • Carotid artery-cavernous sinus fistula. A fistula is an abnormal connection. Thus, carotid artery-cavernous sinus fistula is an abnormal connection between a very large artery and a very large "lake" of venous blood (not really a "sinus" in the sense of facial sinuses) within the cranial cavity. It is usually the result of severe head trauma. The fistula can be treated by a specialist in the field of interventional radiology.
  • Venous hum. Patients who are pregnant, are anemic or have thyroid problems may develop increased blood flow through the largest vein in the neck, the jugular vein. The jugular vein carries blood from the brain back to the heart. In so doing, it traverses the middle ear. Turbulent blood flow anywhere in the course of the jugular vein can be heard in the middle ear as a "hum" which may or may not fluctuate with the pulse. Correction or resolution of the underlying problem often results in improvement.

There are other, less common, causes of pulsing in the ear, but these are the "biggies." I recommend that you see an ear, nose and throat specialist for a comprehensive evaluation, because (as you can see from this list) many of the possible explanations are NOT trivial!


by Douglas Hoffman