I Feel My Tinnitus Often Aligns with My Heartbeat — Possibly Pulsatile Tinnitus?

[Jerad]

I am having the low hum, vibrational, car engine idling, drumbeat sound in my left ear. It has a revving up and down sensation to it and I can feel it, too (vibrationally). It morphs between those sounds and can get pretty loud. I consider it very intrusive and my anxiety has been a 10/10 lately due to this. I often feel it aligning with my heartbeat, especially when I first get out of bed and can hear it in tune with my heartbeat thumping.

This "tinnitus" or pulsatile tinnitus got worse recently. It had been around for about 5 years now, but was only a .5 or 1 out of 10 in loudness, so pretty mild. I first noticed the humming after using an inversion table for back issues, which put a lot of pressure on my head and also caused a relapse of hyperacusis /sound sensitivity in 2016. The hyperacusis eventually improved and the hum rested at a 1 or less out of 10. However, recently it ramped up to a much higher and intrusive level, perhaps a 5-8 in loudness depending on time of day. It's all over the place. Sometimes it will go down to a 2/3 for a bit. But it's usually a short time and it's back up to a higher volume. This seemed to be triggered by using over ear headphones at very low volumes for pink noise therapy, over a 5 day period, as I had recently relapsed on hyperacusis again after using Turmeric for back pain.

After using the headphones, it seemed to trigger this ramped up tinnitus or pulsatile tinnitus. I don't know if it's hearing loss in the low frequencies from the headphones which elevated my perception of true pulsatile tinnitus that I already had, or if it's just regular tinnitus.

I had an audiogram that showed no hearing loss, but those don't test at frequencies under 250 Hz. This low frequency tinnitus or pulsatile tinnitus seems to exist in the realm under 250 hz. It's easily maskable with about 35 decibels, but overpowering and loud in silent rooms. It also is seemingly cancelled out or suppressed when confronted by other low frequency sounds. For example, when an airplane flies over the house or a distant train goes by, or someone nearby is cutting grass. That cancels out the noise. It seems to totally suppress it, as I hear silence when it's "cancelled" out and it doesn't appear to be actually just be masking it. Also, when I go for a car ride for a bit, I often experience residual inhibition and the pulsatile tinnitus or tinnitus sounds are gone for a while or lowered significantly (for maybe 30 minutes) before coming back. My ENT had recommended a CT scan with contrast. He also wanted me to do an MRI, but I'm not confident I can handle that with my severe hyperacusis situation at this time.

So my questions...

1. Does this sound like true pulsatile tinnitus, given my symptoms? Maybe a low frequency hearing loss from headphones upped my perception of the pulsatile tinnitus? Or is this just regular tinnitus, even though it is so pulsating and erratic. It did first originate and stay around after the inversion table years ago.

2. Will a CT scan help identify if this is pulsatile tinnitus?

3. Is using contrast necessary? I've read stories on this forum about people having interactions with it and spiking their tinnitus - sometimes permanently (I have regular tonal tinnitus already, too, and I'm generally sensitive to meds).

4. I haven't taken Prednisone, but the ENT gave me a Medrol pack to use if I want to. Would this be of any benefit 2 months into onset? It's 4mg. I have an old pack where I could combine them if wanted to do a dosage that's higher.

@tiniturtle, @Greg Sacramento, @Bill Bauer, @Ben Winders:

I tagged you all since you seem to have some experience with this type of tinnitus or pulsatile tinnitus.

Thanks for the help. I appreciate it.

 

[Sookat]

Does your tinnitus change at all if you clench your teeth? I would suggest muting the left side of your headphones, thats what I do and it seems to be helping.

 

[Jerad]

Does your tinnitus change at all if you clench your teeth? I would suggest muting the left side of your headphones, thats what I do and it seems to be helping.

Thanks for the reply. I quit using the headphones after the problem started 2 months ago. The tinnitus "spike" has been mostly the same over the two months with just occasional periods of it quieting for a few hours. I can't change it with clenching my teeth. It stays the same. But sometimes if I breathe in or talk it changes in the way it sounds.

 

[Ronert]

Greetings.

We must be synced. Sadly, your description is 100 percent the same as my condition, which began in August.

At least your ENT has made some recommendations. I went to a neurologist and I convinced him to have a CTA of head and neck with contrast, checks for blood flow issues.

I wish us the best as this is a horrid condition to try to deal with.

Armond

 

[Greg Sacramento]

@Jerad, hypertension or a hypertension event is the most important contributing risk factor for a cerebrovascular event or diseases as it can change the structure of blood vessels and that could also result in atherosclerosis.

The use of an inversion table can cause rising blood pressure and instant pulsatile tinnitus. With also using an inversion table, negative pressure may have developed in the middle ear leading to low frequency hearing loss (you do seem to have this). Early on, negative eardrum pressure can also cause multiple tones and hyperacusis. Eardrum pressure should resolve, but you will still have some low frequency hearing loss.

I really don't think that you have serious blood vessel changes, not at all, but do get a CT scan with contrast.

Just my take, not completely sure - but again I don't think that you have serious worries. Staying calm will be your best friend.

 

[Jerad]

@Jerad, hypertension or a hypertension event is the most important contributing risk factor for a cerebrovascular event or diseases as it can change the structure of blood vessels and that could also result in atherosclerosis.

The use of an inversion table can cause rising blood pressure and instant pulsatile tinnitus. With also using an inversion table, negative pressure may have developed in the middle ear leading to low frequency hearing loss (you do seem to have this). Early on, negative eardrum pressure can also cause multiple tones and hyperacusis. Eardrum pressure should resolve, but you will still have some low frequency hearing loss.

I really don't think that you have serious blood vessel changes, not at all, but do get a CT scan with contrast.

Just my take, not completely sure - but again I don't think that you have serious worries. Staying calm will be your best friend.

Thanks @Greg Sacramento.

Do you think a CT scan would detect something that could be causing these humming, turbulent, engine idling noises? Something that maybe a surgery could correct? Honestly I would love to find something and get it fixed because these sounds are very intrusive. Is contrast dye really necessary? Thanks again for the help

 

[Greg Sacramento]

@Jerad - Hi Jerad, yes I would follow your doctor's advice and get a neck CT with constrast dye.

Before your appointment ask the radiological tech to borrow noise blocking headphones from the MRI room. A CT neck or head exam isn't too loud, but I would still use noise blocking headphones.

 

[cml]

Hello, my left ear is affected. I have been trying for weeks to describe this sound and you describe it perfectly. I also feel the vibration. I realize it at night when I do to bed and wake in the night and the morning. I use a Neti pot and it seems to help in the morning before work. I work at a coffee shop and do not notice the sound or sensation.

I have a ringing sensation in my right ear and this hum in my left. I have been having problems with both ears since mid August. I saw an ENT Friday and he said all was good. He did not have an answer for the left ear. I have a nasal scope with good results. Had a tube put on October 4 and had it removed from right ear October 8 due to whooshing sound in the right ear. When the tube was put in the left ear went completely out of whack.

I called for appointment with neurologist. Booked until early March.

I have neck tension and upper bad tightness with anxiety. The back of my head has muscle tension.

Are you really sure this could be pulsatile tinnitus?

This feeling is very frightening to me. Thanks.

 

[Jerad]

I'm not so sure it's pulsatile tinnitus truly. Maybe @Greg Sacramento can help us determine that further. So when an airplane flies over my house or some other low frequency sound, or even the refrigerator, it completely seems to suppress the "tinnitus noises" — it doesn't seem to be masking them because I hear silence when the plane flies over, for example. So I don't know if it's synapses that have been damaged or nerves. My issues seemed to have stemmed from when I used headphones at low volume for pink noise therapy. I didn't know of the risks before seeing this forum. I have deep regrets. However, I DID have this humming sound prior to that, but at a much lower volume. So the headphones seemed to either jack the volume up or they caused some hearing loss which allows me to hear the "pulsatile" tinnitus better now. I fear it's hearing damage. I wish it was pulsatile tinnitus though because then maybe surgery can fix it. Reason is, this problem has become debilitating. Today was a terrible day. The ear has been like an 8/10 all day and it's so intrusive. I dunno how to live with this especially on top of hyperacusis.

 

[Wrfortiscue]

Get the contrast. It will show more. CT with contrast is definitely safer for hyperacusis folks vs an MRI.

 

[cml]

Jared or anyone,

Has anyone experienced a bass sound in your ear when watching TV or listening to low music?

And does your ear vibrate and can you feel it? This is in the same ear for me which hums.

Help.

 

[Jerad]

@cml, I noticed my bass sound is reactive and sometimes seems to react to the house A/C system and noises outside that match its frequency. Not sure if it's the hyperacusis causing it to be reactive or what. And yes, I get the vibrations significantly with the humming ear (left ear).

What caused your humming? Do you know? Was there an event that seemed to coincidence with its onset?

 

[Greg Sacramento]

@cml, not pulsatile tinnitus in left ear with hum and vibration while lying down. Possible prior cold/virus and chest congestion may be the cause of past fluid behind ear drums - still causing middle ear muscle reaction in a lying position. Prior chest congestion could also be the cause of a tight back and sore neck muscles. If all so, left ear hum may soon not be noticed when lying down.

I would discuss with your regular doctor for complete blood work - CBC. This would provide a lot of useful information.

 

[Jerad]

@Greg Sacramento, do you think my issue sounds like pulsatile tinnitus, given the symptoms: for instance, when an airplane flies over my house or I'm around some other low frequency sound, even the refrigerator, it completely seems to suppress the "tinnitus noises" — it doesn't seem to be masking them because I hear silence when the plane flies over, for example. So I don't know if it's synapses that have been damaged or nerves, or pulsatile tinnitus.

My issues seemed to have stemmed from when I used headphones at low volume for pink noise therapy. I didn't know of the risks before seeing this forum. I have deep regrets. However, I DID have this humming sound prior to all that, but at a much lower volume. So the headphones seemed to either jack the volume up or they caused some hearing loss which allows me to hear the "pulsatile" tinnitus better now.

I notice when laying down the noises seem smoother and less intense. It changes them.

 

[Greg Sacramento]

I'm around some other low frequency sound, even the refrigerator, it completely seems to suppress the "tinnitus noises"

A New Method for Assessing Masking and Residual Inhibition of Tinnitus

Google: New methods for assessing masking and residual ...
Google: Tinnitus residual inhibition

This is complicated and many researchers have different study opinions.

-------------------------------

You mention medication ototoxicity as first sign of tinnitus.

Does this sound like true pulsatile tinnitus, given my symptoms? Maybe a low frequency hearing loss from headphones upped my perception of the pulsatile tinnitus? Or is this just regular tinnitus, even though it is so pulsating and erratic. It did first originate and stay around after the inversion table years ago.

I DID have this humming sound prior to that, but at a much lower volume. So the headphones seemed to either jack the volume up or they caused some hearing loss

This I do know: The use of an inversion table can cause rising blood pressure and a hum, pulsating, erratic sounds, and even thumping to heart beat. With also using an inversion table, negative pressure may have developed in the middle ear. Early on, negative eardrum pressure can also cause multiple tones and hyperacusis. Sometimes the Stapedius is considered, but lots more could have involvement. ENTs often don't know more.

Your doctor recommends a CTA, as maybe considering your use of an inversion table. Doctors at hospitals where I worked, also ordered a CTA or MRA for sounds heard after using an inversion table. Blood pressure monitoring and ENT examinations with more ENT outpatient examinations. ENT examination was mostly just possible theory, if that, but CTA/MRA often noted a problem.

 

[cml]

Greg/Jared,

I was in Denver for a week last week of July. Flew back and upon decent my right ear had severe pain and in ability to pop. After landing it adjusted. However, by August 11 I had ringing, ringing, pain, muffled hearing which last rest of August and all September. I was on those pills for 2 months.

Hearing test September 21 and all was good.

I have never had an ear ache all of my 46 years or any other problem.

This buzz/ hum/vibration comes at night. There is also ringing in this left ear. The right ear always has had a ring.

What do you suggest to proceed when 2 ENT have said everything is fine?

Thanks.

 

[Greg Sacramento]

@cml, you probably know this:

When a plane takes off and lands, the air pressure changes and the ears need to adapt. Until the Eustachian tubes equalize the pressure, the difference between the inside and outside pushes on the eardrum. This pressure difference causes it to hurt and not work properly. Sounds may also become muffled. Eardrum problems usually correct by two months or so.

Since 2 ENTs said everything is fine, I would consider blood work for infection if you had allergies or a cold before or during flying.

The discomfort of airplane ear worsens when flying with a cold, nasal congestion or allergies.

Wishing both you and Jerad recovery.
I won't be able to post going forward.

 

[tiniturtle]

These are exactly the symptoms I had with my DAVF. Get an MRA, and talk to a neuro-interventional radiologist for a consult. This is completely out of the wheelhouse of audiologists and ENTs.

 

[Jerad]

@tiniturtle, when you had the DAVF, did the sounds go away when confronted by other sound?

For me, for instance, when an airplane flies over my house or I'm around some other low frequency sound, even the refrigerator, it completely seems to suppress the "tinnitus noises" — it doesn't seem to be masking them because I hear silence when the plane flies over, for example. So I don't know if it's synapses that have been damaged or nerves, or pulsatile tinnitus. I had these noises much, much lower before, but they seemed to have gotten louder from when I used headphones at low volume for pink noise therapy. So I'm not sure if that caused some hidden hearing loss which allows me to hear this pulsatile tinnitus better or if it's just hearing damage.

 

[tiniturtle]

@tiniturtle, when you had the DAVF, did the sounds go away when confronted by other sound?

For me, for instance, when an airplane flies over my house or I'm around some other low frequency sound, even the refrigerator, it completely seems to suppress the "tinnitus noises" — it doesn't seem to be masking them because I hear silence when the plane flies over, for example. So I don't know if it's synapses that have been damaged or nerves, or pulsatile tinnitus. I had these noises much, much lower before, but they seemed to have gotten louder from when I used headphones at low volume for pink noise therapy. So I'm not sure if that caused some hidden hearing loss which allows me to hear this pulsatile tinnitus better or if it's just hearing damage.

I mean, speculation is an act in futility. I would go get it checked out. Pulsatile tinnitus by its nature is intermittent, and not at all related to "ordinary" tinnitus. With pulsatile tinnitus, you are hearing just fine, you're just hearing turbulent blood flow in your head.

I also have "ordinary" tinnitus from a different cause which is completely separate.

 

[Jerad]

Thanks @tiniturtle. I agree - but did your pulsatile tinnitus behave the same way that my sounds are?

Like when someone talks to me, the sounds stop and then continues after the person finishes talking. Or when an airplane or another sounds is in the distance, the "phantom" tinnitus or pulsatile tinnitus sounds again stop and then starts after the other sound passes.

So whenever it's confronted by another sound, it seemingly suppresses the phantom or pulsatile tinnitus sounds (doesn't seem to be just masking them).

I'm not sure if true pulsatile tinnitus behaves that way.

 

[Greg Sacramento]

Like when someone talks to me, the sounds stop and then continues after the person finishes talking. Or when an airplane or another sounds is in the distance, the "phantom" tinnitus or pulsatile tinnitus sounds again stop and then starts after the other sound passes.
So whenever it's confronted by another sound, it seemingly suppresses the phantom or pulsatile tinnitus sounds (doesn't seem to be just masking them).

Computer-automated tinnitus assessment: noise-band matching, maskability, and residual inhibition

From the link that I gave in post #15 above. I would spend some time reading that article and the included reference studies and their references at the bottom for more types of treatment.

"Some patients were able to report a possible etiology of their tinnitus that included acoustic trauma, stress, work noise exposure, head trauma, sudden hearing loss, acoustic neuroma, and whiplash. However, most patients reported an unknown etiology. The description of the tinnitus also varied between patients with most of them reporting a ringing or a high-pitch sound. Some patients also reported humming, low-pitch, and noise-type sounds."​

Because your hum first started after use of an inversion table, trauma may had also happened. So I would also follow your doctor, tiniturtle and my advice with seeking head/neck radiological examination first.

The use of an inversion table can cause humming pulsatile tinnitus. With also using an inversion table, negative pressure may have developed in the middle ear leading to low frequency hearing loss. Early on, negative eardrum pressure can also cause multiple tones, humming and hyperacusis.

 

[Greg Sacramento]

@Jerad, thinking in agreement from your introduction post, including residual inhibition, that your problem is ear related. This is what I found from more study research.

Downward deflection from using an inversion table could cause the elastic basilar membrane to move down and also increase air pressure within the scala tympani. The enhanced pressure in the scala tympani displaces a fluid mass that contributes to outward bowing of the round window and this can cause humming. The use of headphones later could increase humming as high-frequency sound waves cause maximum vibration of the area of the basilar membrane nearest to the base of the cochlea; and medium-frequency waves affect the centre of the membrane.
Low frequency sounds - refrigerator and planes stimulate the apex of the basilar membrane, thus a hum can temporary disappear - residual inhibition.

The basilar membrane is a stiff structural element within the cochlea of the inner ear which separates two liquid-filled tubes that run along the coil of the cochlea, the scala media and the scala tympani. The basilar membrane moves up and down in response to incoming sound waves, which are converted to traveling waves on the basilar membrane.

One treatment is ultrasound of the first few millimeters of the basilar membrance. Another is hearing aids, but don't know what type.

 

[Wrfortiscue]

I don't mean to hijack but @Greg Sacramento, would you have an idea why my noise induced buzzsaw mostly squeals with my heartbeat, and gets worse if my head is elevated with a pillow, lying down?

 

[Jo Bennett]

My pulsatile tinnitus started as a fan then went to a full on heartbeat but now changed to how you describe. Beating drum, humming and feeling my ear drum vibrating. I can also feel it vibrate if I put my finger in my ear and sometimes this even reduces the noise. This occurs in my right ear even though I have regular tinnitus in my left which has also increased. Hearing tests show only left ear has low tone deafness. I also had a full blown vertigo attack with vision blurness. The say Meniers disease but Im not convinced as I ahve too many other symptoms. I also get a pain that sometimes radiates from the back of my neck up to my right ear. Back of my skull is really sensitive at times. This has just started to occur. I have had this since May this year. Ironically from reading other threads about using headphones etc due to working from home I did commence using a headset around this time. CT scan from vertigo episode all clear and MRI clear. Next ENT has ordered CT on ear temporal bone to rule out a tear as I also hear sounds in my head. Apparently I am not text book case as I have so much going on. My pulsatile tinnititus changes from day to day - sometimes very loud other days like a distant drumming. I also can feel it radiating though my hands at times. I also often get headaches. It is very frustrating and I just hope that one day it will go away and it scares me to think that I will hVe to put up with this hideous condition. I wish us all the best of luck in getting to the bottom of our condition. At least we understand what each of us is going through.

 

[Jo Bennett]

@tiniturtle - do you think my symptoms could be same as your diagnosis?

 

[Jerad]

@Greg Sacramento, thanks for the detailed information and analysis.

Is this something that can heal with time? Will the basilar membrane issue settle or improve over time? It's been about 2.5 months and I've been getting worse, it seems. I haven't done anything that should've worsened things - I've been careful and protective, but I'm just so sensitive and fragile that it seems like things keep getting worse. I'm not overprotective either. I do allow myself to take in sounds.

Also, I did the CT scan with contrast and the results show possible superior canal dehiscence on my left ear (which is the one with the problems). My ENT is having me see a neurologist now. Could this explain any of my symptoms (severe tinnitus and hyperacusis)?

 

[Greg Sacramento]

@Jerad, the round window which is involved in the release of sound from the scala tympani is obvious to be a possible concern. A CT with contrast would note this. More focus temporal bone study may now be ordered by neurologist along with other tests, including tests performed in the neurologist's office.

Stay in touch.

 

[Greg Sacramento]

@Wrfortiscue, if I remember right, your MRI was clear and your vestibular therapist wanted you to get an ECoG.

For you and @Jo Bennett, I would consider a neuro-interventional radiologist.

 

[tiniturtle]

@tiniturtle - do you think my symptoms could be same as your diagnosis?

I am not qualified to answer that, and neither is anyone on this forum. Go see a qualified specialist.