Pulsatile Tinnitus — What Should I Get Checked?

[Louise]

5 days ago I had PT start very, very suddenly. I can hear my heart beating in my ear loudly. Sometimes I get a pulse banging and thumping in my ear.

From what Ive read there is a physical cause for PT and its normally vascular. But there seem to be so many possible causes.

What should I have tested first?

I've just seen an ENT and he said the usual cause is Carotid Canal Dehiscence. Where the canal bone breaks a bit and the artery comes further out and closer to the ear. He's recommended a temporal CT scan.

The thing is that my ear feels wrong, full, and my voice sounds all inside my head. I'm also not hearing the TV normally. So to me it seems like blocked ears/sinus/Eustachian but ENT said no sinus issues. But he didnt do anything to check! I had a test where a device was put in my ear and suction applied. Its to test that the eardrum is moving. But my left side, where I hear the heartbeat, had to be repeated as the first one showed no 'peak' and the second time only showed a slight peak on the scope. The ENT seemed to think nothing of it but surely that means the eardrum isnt moving properly?

My ears are also crackling when I yawn etc and thats not normal for me.

Any help appreciated.

 

[Ambassador]

When I first started my ENT did all the testing he could do in the office then sent me for a carotid ultrasound to look for narrowed carotid arteries which can sometimes be heard and are an increase risk of stroke. It's quick and easy and relatively inexpensive in the US.

 

[glynis]

Can be due to blood pressure also hearing loss and picking up your Caroted Artery pulse.
Love glynis

 

[Karen]

The first test I had for pulsatile tinnitus was a CT scan of the temporal bone, to rule out dehiscence. That is one of many possible causes. I also had crackling in the ear, and ear fullness, when my PT first started. However, in time, those symptoms have gone away. I still have the PT, but without any of the other uncomfortable side effects.

A couple of suggestions: You could have a dentist check to make sure you don't have a jaw issue, such as TMJ. Another possible cause, besides the ones Glynis mentioned, is benign intracranial hypertension. A physical would need to check for that, and you might want to consider going to a specialist such as a neurologist or neurotologist. The specialist might suggest additional testing, such as an MRI or a CT scan, to rule out other causes.

Good luck, and I hope you'll keep us posted on what you find out.

Best wishes,
Karen

 

[Louise]

Thanks Karen. Just the advice I was looking for.

The ENT did tell me about dehisence and doing a CT scan for it. He also said if it is that for most people the body makes the vein hard in that area and the noise goes away or becomes a lot less.

I do have TMJ issues. Have done for decades. Never done anything for it. Could that suddenly cause PT after all these years of it not causing a problem?

How do they check for intercranial hypertension? And would that be the neurootologist?

In sure today it was gone. That is until I just took a Niacin tab andhad a huge Niacin flush. I could hear the heartbeat again. Seems to be lessening.

Did yours start so suddenly like mine?

Did you find out the cause of yours?

Can you habituate it? Doesnt seem possible to me. Its worse than my usual T.

 

[Karen]

Hi, @Louise,

By the way, it is good to hear from you again, although I'm sorry you are experiencing PT symptoms.

I don't know if it is possible that the TMJ could suddenly cause PT; that would be a good question to ask a dentist or TMJ specialist. I know that was one of the first things I had checked out when mine started. The doctor didn't think I had a jaw problem, after assessing my bite, etc. He did suggest taking flexiril, a muscle relaxer. I have since taken a muscle relaxer, but it didn't help the pulsating.

I'm not totally sure how they check for intracranial hypertension, but I believe that they can tell something is amiss by an eye test, by looking at the veins. However, it would still be a good idea to see a neurologist or neurotologist, as they have more knowledge about PT than an ENT would. And I'm sure they would be knowledgeable about intracranial hypertension, as well.

To answer your question "Did the PT start suddenly?" Yes, mine started suddenly; I first noticed it at night, when I was trying to go to sleep. Mine seems to have started after I took a blood pressure drug for the first time. Before that, I had regular tinnitus only, but it was mild and not bothersome. After the blood pressure drug, my regular tinnitus got worse, and the PT started.

I have never found the cause for mine. However, there are a couple more tests I could have done, including a CT scan with contrast (I was afraid of the iodine), and an angiogram (it has some risk of stroke).

I have somewhat acclimated to mine; or rather, I have learned how to live with it. Mine doesn't bother me too much during the day, it's at night that I sometimes still have problems. So, to remedy that, I try not to go to bed until I'm really tired and ready to fall asleep. That makes it easier.

Best wishes,
Karen

 

[Karen]

Here is an article I just found from the BTA about pulsatile tinnitus:
https://www.tinnitus.org.uk/pulsatile-tinnitus

 

[Tinniger]

If your pulsatile tinnitus had been your very first contact with tinnitus, I would recommend an angio-MRI.
In the case of preexisting tinnitus and pulse synchronicity discovered afterwards, the answer is more difficult. Nevertheless, an Angio-MRI would exclude a carotide dissection, - among other things....

 

[Louise]

Thanks Karen and Tinniger.

It is good to speak with you again. When I posted I remembered you had PT and was hoping you'd reply

Strange thing is that the original T which worsened at Christmas I hardly notice now this PT arrived.

Its calmed down though. This morning I could hear slight blood flow thats all. No heartbeat. Im trying not to check as I'm sure it follows the same Tinnitus rules in that once tge brain locks onto it and sees it as s threat itll start amplifying it.

I've read a few accounts of BP drugs csusing it to start. How odd - you'd think it would be the other way around.

This has to have a physical cause that they can find.

I saw a Neuri-otologist on NHS when it started 5 years ago and on Tuesday I'm asking the doc to re-refer me. I really dont want to wait though

 

[Louise]

When I first started my ENT did all the testing he could do in the office then sent me for a carotid ultrasound to look for narrowed carotid arteries which can sometimes be heard and are an increase risk of stroke. It's quick and easy and relatively inexpensive in the US.

Thanks. I'm arranging that myself tjis week. Its £100 to do privately here and you can get straight in.

 

[Louise]

Hi Karen,

I read the article, thanks.

Wonder if it is heightened awareness? I was in a state over the regular T at the time. But the suddenness with which it started makes me think a more physical cause?

Getting a tympanogeam on Weds. The one I had on Friday did show issues I thought.

Do you think extreme muscle tightness in the neck could cause it? Ive not read that it can.

X

 

[Karen]

Hi, Louise,

You are right that the cause of PT is usually a physical issue, and it may be fixable once that cause is found. In my case, the pulsating started after taking a blood pressure drug, so that may be why I haven't found a physical reason for mine.

Could muscle tightness in the neck cause it? I don't know, but I'm sure anything is possible. I will be interested to hear what your doctor has to say.

If no cause is found, you can live with it by remaining calm, keeping busy, following a good diet, and keeping blood pressure at a good level. That's what I'm doing right now, and it seems to help.

I've heard that another possible cause is underactive thyroid, or at least it makes you more susceptible to this condition, and I do have an underactive thyroid. Do you know of any other changes that may have occurred at the time your PT started, or did it just start out of the blue?

Take care, and I'm glad yours is calmer today.

Karen

 

[Louise]

Thanks Karen. I do have underactive Thyroid but its really well managed with Novothyral.

It started bang out of the blue. Was laid awake at 5.30am and suddenly it was in my ear extremely loud. Like a window to my inside had been flung open. Just like that, nothing one second and loud noise the next. I just don't get it.

I had been suffering intolerable anxiety for 3-4 weeks from the normal T worsening. But I don't think it was that because of how it started so suddenly and loudly.

I'm asking to be re-referred to the neuro-otologist on Tuesday. So hope the doctor will.

X

 

[Karen]

Thanks for the update, Louise. I'm glad yours is well-managed; so is mine. I do think underactive thyroid may make our ears more susceptible to tinnitus, but I'm not sure about pulsatile tinnitus.

Yours truly did start out of the blue! Very strange, and I hope your doctor is able to find something specific, so you will at least know what caused it.

Good luck, and please keep us posted. I'd like to know what your doctor has to say!

Best wishes,
Karen

 

[Louise]

My doctor won't have a clue Karen It's that neuro-otologist I need. Bound to be a long waiting list though

It cant be anxiety can it just coming in bang like that?

I was doing HBO for 2 weeks before it but I've done that in times past with no ill effects.

Another thing I did different was 2 days before I took a Lithium Orotate supplement, just one 5mg. The next morning the regular T was so low almost gone. So I took another that night and next morning got this PT. I don't think it was the Lithium Orotate though, think that was a coincidence.

 

[Louise]

I forgot something..... fir about a week I'd been taking 3mg Melatonin at night.

 

[Louise]

I've got high BP too but I do think I have had before.

 

[Tinman207]

Have you read about a Patulous Eustachian tube? Hearing your voice and the noise in your head amplified sounds a lot like what happens with this condition.

 

[Louise]

Have you read about a Patulous Eustachian tube? Hearing your voice and the noise in your head amplified sounds a lot like what happens with this condition.

Thanks. I haven't heard of this but will research it.