Intermittent Pulsatile Tinnitus in Left Ear, High Blood Pressure

[Stefanie]

Hi Dr. Nagler,

I hope I am posting this to the right place. This is my 1st post here ever.

Anyways, I developed intermittent PT in my left ear in Nov. 2019. By intermittent I mean I hear whooshing daily, it's just not 24/7 non-stop. I've had my hearing checked, all normal.

Had an MRI, all normal. My blood pressure, and fasting blood sugar has come back as high. Not high enough to be put on meds but high enough to where my Dr. has strongly urged me to lose a lot of weight (like 100 lbs).

My Dr. has told me that the PT may be (and most likely) is caused by my high BP. He said hopefully once I shed my weight the PT will back off. He mentioned something about the blood flow being turbulent due to high BP and that's why I can hear it.

Having anxiety (OCD), I am questioning if my Dr is right.

Why can I only hear it one ear? What are the chances it will back off when I get my BP under control? I'm afraid I will never be cured of this whooshing and stuck with it forever. I'm only 38. :-(

 

[Dr. Nagler]

Hi @Stefanie, and thank you for your question.

Let's start with the reason your doctor ordered the MRI along with examining you and looking at your audiogram, etc. The whole idea is to make sure that whatever is causing your tinnitus, it is not something that can be fixed with the expectation that fixing it will eliminate your tinnitus (which unfortunately is rather rare) and it is not something that is a threat to your health (which fortunately is extremely rare). If you have unexplained tinnitus in one ear, often the doctor will order an MRI to rule our a benign (non-cancerous) tumor along your auditory nerve on that side, which can cause problems as it grows. MRIs are generally not ordered if a person has symmetrical tinnitus in both ears. Now the fact that your tinnitus is pulsatile adds another wrinkle into the works. Many doctors feel it is important to rule out a problem with the blood vessels in the vicinity of the inner ear that can cause the pulsations because sometimes these problems can be surgically corrected. Your doctor may have felt that the MRI was sensitive enough to do the trick in your case. Another option would have been to order in MRA (Magnetic Resonance Angiogram) to delve deeper into the matter if your doctor had those sorts of concerns. I tell you this just to give you an idea of what your doctor might be thinking. Also, he or she has the benefit of knowing you and having examined you, which puts me at a distinct disadvantage in trying to help you navigate these waters. I could be totally off base!

All that said, here is how I look at it. I do not order tests unless the results would lead me to make some sort of recommendation to a patient. In your case, the only reason to do an MRA would be to find something that could or should be repaired surgically. But according to your own post, you are in the neighborhood of 100 lbs. overweight, which makes you a terrible surgical candidate. Plus, every day you risk a heart attack, stroke, diabetes, etc. at that weight. So the prudent course would be to lose the weight as your doctor recommended - and then if the pulsatile tinnitus were still a problem for you (it well might not be!) consider moving ahead with the MRA at that point. I hope that makes sense - and, again, I ask you to keep in mind that I can only work with what you have told me.

Why do you hear your tinnitus in only one ear? Well, we know you do not have an acoustic neuroma because you have a normal MRI, which presumably was ordered to rule out that sort of thing. So one of several possibilities is that the hearing in your left ear might be slightly worse than the hearing in your right - and the brain tends to put the tinnitus in the weaker ear.

Hope this helps.

Stephen M. Nagler, M.D.