Pulsatile Tinnitus: When to See a Specialist

Pulsatile tinnitus is a distinct and often alarming auditory sensation where an individual hears a rhythmic sound, such as a thumping, whooshing, or pulsing, that is synchronised with their own heartbeat. Unlike the more common, steady forms of tinnitus, this condition frequently points to a specific, identifiable underlying cause related to changes in blood flow near the ear. While many of these causes are benign, some can be serious, making a prompt and thorough investigation essential. At our private audiology clinic in Loudwater, High Wycombe, we specialise in the comprehensive assessment of tinnitus, providing the crucial first step in diagnosing the cause and guiding patients toward the appropriate management pathway.

The defining characteristic of pulsatile tinnitus is its rhythmic nature, which mirrors the patient's pulse. As your heart rate increases during exercise or moments of anxiety, the sound you hear will speed up accordingly. This phenomenon occurs because you are, in effect, hearing the sound of blood circulating through vessels located near your auditory system. This can be due to either a change in the blood flow itself, or a change in your perception that makes you more aware of it.

In some cases, the sound of pulsatile tinnitus is 'objective,' meaning that during an examination, a clinician may also be able to hear it by using a stethoscope on or near your ear. More commonly, it is 'subjective,' audible only to you. Regardless, the presence of this symptom is a clear signal that a specialist evaluation is necessary to investigate its origin.

Pulsatile tinnitus is not a disease in itself, but a symptom of another condition. These causes are diverse and can be broadly categorised into vascular, structural, and other systemic conditions. Identifying the specific cause is the primary goal of an investigation.

Your journey to a diagnosis begins with a comprehensive audiological assessment. As a leading independent audiology clinic in the High Wycombe and Loudwater area, Buckinghamshire Hearing provides an in-depth evaluation that forms the bedrock of your diagnostic pathway. Our process involves:

• In-Depth Consultation: We take a detailed case history, listening carefully to your description of the sound, when it started, its impact on your life, and any other associated symptoms such as hearing loss, dizziness, or headaches.
• Clinical Examination: This includes a thorough otoscopic examination of your ears to check for any visible abnormalities. We may also perform auscultation, using a stethoscope to listen to the area around your ear and neck to determine if the sound is objective.
• Comprehensive Audiological Testing: We conduct a full suite of diagnostic tests, including Pure Tone Audiometry and Tympanometry. This allows us to precisely measure your hearing thresholds across different frequencies and assess the health and function of your middle ear system. This is vital for identifying any concurrent hearing loss which could be contributing to your awareness of the tinnitus.

This detailed assessment allows us to build a complete picture of your auditory health and provide essential information for an onward referral to an ENT consultant or neurologist.

While pulsatile tinnitus itself warrants investigation, certain 'red flag' symptoms require more urgent attention. According to UK guidelines from NICE (the National Institute for Health and Care Excellence), you should seek immediate medical advice if your pulsatile tinnitus is accompanied by:

• Sudden or severe headache
• Neurological symptoms like facial weakness, vision problems, or difficulty speaking
• Sudden, unexplained hearing loss
• Balance problems or vertigo

Following your audiological assessment, the next step is typically a referral to a specialist for medical imaging. This is crucial for visualising the blood vessels and structures in your head and neck. The type of scan recommended will depend on the suspected cause, but common investigations include:

• MRA (Magnetic Resonance Angiogram): Uses MRI technology to create detailed images of blood vessels.
• CTA (Computed Tomography Angiogram): Uses CT scanning with a contrast dye to visualise arteries and veins.
• MRI/CT Scans: To examine the brain, temporal bones, and surrounding structures for any abnormalities.

Our role at Buckinghamshire Hearing is to ensure you are on the correct pathway from the very beginning, armed with the detailed audiological data that specialists require.

One of the most reassuring aspects of pulsatile tinnitus is that its treatment is often highly successful once the underlying cause is identified. Treatment is not for the tinnitus itself, but for the condition causing it. This can range from medication to manage blood pressure or anaemia, to surgical or endovascular procedures to correct a vascular abnormality. For example, venous sinus stenosis can often be treated with a small implant called a stent, which resolves the turbulent blood flow and, in many cases, the tinnitus.

In situations where a direct cause cannot be found or treated, management focuses on reducing the intrusiveness of the sound and its impact on your quality of life. This can include sound therapy, using devices to create a neutral background noise, and psychological support such as Cognitive Behavioural Therapy (CBT) to help you manage your reaction to the tinnitus. If you also have a hearing loss, fitting a well-programmed hearing aid can be incredibly effective, as amplifying ambient sounds can make the tinnitus much less noticeable.