Pulsatile Tinnitus That Comes and Goes with a Daily Pattern

[John3D]

Hi everyone

I've had pulsatile tinnitus in my right ear for the last five years now, it sounds like tv static and gets louder if I bend over or climb stairs. When it's particularly bad it can be extremely loud and sounds like it has a lot of force behind it.

It's not constant but it tends to come on after lunch and after work (about an hour after leaving my desk, lasting for a few hours after.) I haven't found any position, stretch or area i can apply pressure that will reduce the noise, I've only ever been able to wait it out.

I also get numbness around my right cheekbone, fluttering eardrum jaw pain and soreness around my right mastoid process, though not necessarily at the same time as the tinnitus. I also used to get the sensation of bobbing up and down like on a boat when i was stressed and if I overdo it jogging I can get the same pulsing tinnitus in my left ear as well.

I've seen an ENT and had a doppler ultrasound of my neck and a CT scan of the structures of my inner ear, everything came back fine. My GP doesn't want to refer me for any more tests till my anxiety issues are resolved.

I hope someone can shed a light on this or suggest what I can do next as I'm getting more and more assisted by this and paranoid about aa strok or similar life changing issues.

Thanks for your time
John

 

[Holthearing]

Hi John3D.
You have done the correct thing in going to your GP and ENT. It is in the first instance what we suggest to do as correctly you have ruled out some causes of tinnitus.
The next steps would be to either visit your GP for further referral via NHS, as anxiety and tinnitus as you may be aware are interlinked. I am unsure of the reasons why a referral would not be generated on the basis of anxiety as for us in this circumstance we find that a referral would be most important. There are many different ways to manage tinnitus using sound enrichment, sound therapy, cognitive therapy and education via both NHS and private tinnitus specialists. Your GP should be able to refer you to either upon your request.

I myself work for a private company whom specialise in tinnitus assessment and management, but we still like to offer advice to any one whom asks for it on these sites as we understand the impact this can have. I hope you manage to find a solution via your GP and I am more than happy to talk to you should you have any other questions.

Many thanks
Aimee

 

[SilentQ1989]

Hi John3D,

Since you're saying it happens at the same times every day, then maybe you can try doing something different around those times of the day. Sorry, I don't have specific suggestions, just a thought. Do you see the same pattern on days when you don't work?

 

[John3D]

Hi SilentQ, thanks for your reply,
I normally get tinnitus around the same time, wheni stick to the same routine, on weekends the time and severity can vary but It always shows up at some point. I've tried various experiments, staying in bed all day or staying on my feet all day for example won't prevent me from having an episode of tinnitus, it seems like the time of day or severity can vary based on what I'm doing that day bit I'm not able to skip an episode when it's due. To my knowledge i haven't had a day without my PT showing up at some point in the last few years.

The pattern seems to be fatigue or inflammation to me, as the day goes on I get more sensitive to changes in blood pressure, some mornings I could do a handstand and not hear anything, but most evenings there's nothing I can do but wait for the noise to subside (attempting a handstand would be deafening). Which leads me to think there must be at least some musculoskeletal element to it, but I find to very difficult to add strength/posture training to my routine as I'm extremely prone to fatigue and overdoing things can ruin my whole week sometimes.

 

[John3D]

One thing I have noticed more recently is that I can cause the noise to "spike" suddenly NY yawning particularly deeply, at this point I'm still not sure if that indicates a cervicogenic cause or eustachian dysfunction, but it does seem to be muscular in some way.

 

[Lost life]

pretty much we all can. it's called somatic tinnitus.

 

[John3D]

Hey everyone, I've just had possibly my worst episode of pulsatile tinnitus today, I've been doing more anxiety and muscle relaxation exercises and it seems that as a result my episodes of pulsatile tinnitus are briefer but more intense. Today as I was walking of a particularly stiff neck I got the sensation like the whole side of my head was throbbing and ringing, and as i got more panicked my heartbeat and the noise got even louder. I'm starting to think that there's a muscle lashing something down and the tinnitus I get is the catharsis of that easing off, but I don't have a clue where or what it could be.

 

[Karen]

Hi, @John3D,

I have pulsatile tinnitus in my right ear, too -- for about 8 years now. Mine started after taking a blood pressure drug for the first time. It is constant, and there is nothing I can do to stop or control it. However, some days are better than others, and I find that if I keep busy, I can tune it out during the day most of the time.

I was wondering if you have considered having an MRI, to rule out any venous or arterial problems. You might consider going to another doctor if your current doctor won't refer you for this test. Along with the MRI, you can request an MRA (arteries) and MRV (veins).

Your suggestion that it might be muscular is interesting, but it would take an understanding and knowledgeable doctor to help you determine if that could be the cause.

Have you considered going to a specialist, such as a neurologist or neurotologist, for another opinion?

 

[Halsy]

Hey everyone, I've just had possibly my worst episode of pulsatile tinnitus today, I've been doing more anxiety and muscle relaxation exercises and it seems that as a result my episodes of pulsatile tinnitus are briefer but more intense. Today as I was walking of a particularly stiff neck I got the sensation like the whole side of my head was throbbing and ringing, and as i got more panicked my heartbeat and the noise got even louder. I'm starting to think that there's a muscle lashing something down and the tinnitus I get is the catharsis of that easing off, but I don't have a clue where or what it could be.

Why hasn't your ENT sent you to a neurologist? The problem is very clearly in your C-spine. As it is for virtually everyone with a somatic based tinnitus. It could also be a fistula (blood clot) or stenosis (collapsed vein), however you won't know that until a neurologist gets a high contrast MRI or your brain and C-spine. I'd bet dollars to donuts that you have disc degeneration and osteophytes (bone spurs) in your neck - particularly on the side your PT is. After a neurologist makes an assessment they'll decide whether you should be referred to a neurosurgeon for a more in-depth look at the problems and the solution.

When this sort of thing occurs the foramina is generally impigned by the combination of the collapse of the disc and the bone spur. This causes T as a secondary effect. If it can't be resolved through physical therapy - than surgery is required. Given the length of time you've suffered from the condition it seems more likely than the resolution would be surgical in nature, as somatic based PT generally resolves itself in a 6-18 month time frame on average. There are outliers on that where it can last years but it's rare. So if your audiometry reports are ok and the ENT can't find a problem than the problem isn't your ears and likely never has been.

It wouldn't hurt to see a physiotherapist as well - but only after a determination has been made on your C-spine. Spinal traction and/or inversion can help. And if you find the trapezius - also on the same side as the PT - is in tone - tight/stiff look at massage and dry needling. Osteopathy or chiropractic treatement would also be of benefit.

 

[RicoS]

Pulsating T also most... of it is on the right...did not have for a year but now seems to come back and goes away after some time. Did you check you bloodpressure because when I got that down my PT reduced bigtime and I also lost some weight.

 

[Greg Sacramento]

@John3D Read the section under LOCATION within this first link. @Karen's mention for a MVA is a first consideration.
https://en.wikipedia.org/wiki/Parotid_gland

From all of this you might have some otalgia going on.
https://www.fauquierent.net/otalgia.htm


After having a MVA, nerve treatment can begin if needed. Then some therapy after x ray of c spine if needed as @Halsy mentioned which may include C1 C2 and C3. I think that it's a given that muscle therapy to your sternocleidomastoid is needed.

 

[Greg Sacramento]

@John3D

I tend to think that having discomfort at the mastoid affecting the sternocleidomastoid could be a source. It's a common physical tinnitus problem and often nerves are associated. Therapy for both the mastoid and sternocleidomastoid may be helpful. One sided ringing within physical T many times relates to the mastoid and ringing can be modulated. A MVA and x ray of neck to check for alignment still may be helpful. Just some thoughts.

 

[John3D]

Hi everyone, thanks a lot for all the advice you've been giving, it's good knowing that I'm not fighting this alone.

Having met with my GP again she's agreed that there's no doubt my tinnitus is somatic, however she won't refer me for an MRI for the time being as I've only just started a chronic pain and physiotherapy course, she's agreed we can revisit it in a few months.

(I should also mention I had my neck X-rayed at a chiropractors a few months ago and nothing was flagged up other than a bit of postural asymmetry)

At the moment to be honest I'm not bothered about the noise, I have lived with it for 5 years, I just want some kind of confidence that it's not going to degenerate into something dangerous.

I'd love to know your thoughts on this as I'm still unsure, thanks.

 

[John3D]

Also @Greg Sacramento what you said about the parotid gland seems to be a pretty good fit, would there be any way to verify that this is related?

 

[Greg Sacramento]

@John3D Your ENT would have able to rule out an ear infection. You might have some tenseness of your mastoid and SCM muscles. Have you considered anxiety or nervous concerns which could increase blood pressure during stressful episodes. This in your case may be signing cranial nerves - possible cranial nerve #7. Unless you have TMJ/TMD issues then stress management may be all the treatment that you need if that applies to you.

 

[John3D]

@John3D Your ENT would have able to rule out an ear infection. You might have some tenseness of your mastoid and SCM muscles. Have you considered anxiety or nervous concerns which could increase blood pressure during stressful episodes. This in your case may be signing cranial nerves - possible cranial nerve #7. Unless you have TMJ/TMD issues then stress management may be all the treatment that you need if that applies to you.

You might be on the money there, I have significant health anxiety that leads into muscle tension, immobility and fatigue, I've also got significant jaw tension but my TMJ checked out fine when I had it looked at. I've re-started my yoga routine and will be starting a chronic pain management course soon as well as talk therapy.

Interestingly I rarely have pulsing T that's umanagable during exercise, though it can become more consistently noticable in the hours/days following moderate exercise, which makes me think muscular inflammation may be related in some way.

 

[John3D]

Okay, following a tense day of work (neck tension and right jaw numbness/pressure) I've managed to make my vertigo worse, the movement is up and down and seems to be triggered by moving the head and possibly changes in blood pressure, (I felt like i was sinking in to the floor slightly as I stood up to walk somewhere,) I've experienced this previously a few years ago, last time my anxiety was bad so I'm wondering if i should be alarmed now.

 

[Greg Sacramento]

@John 3D What you describe could be cericogenic. That would include vertigo, blood pressure changes, certain head movements, neck pain, jaw tension, and lack of posture control. Head, jaw and/or neck injury is almost always the cause. This can many times correct on it's own, if stress isn't a large factor. But you had several tests, so it may just be a pitched nerve or an extension of a muscle when you turn. Therapy may be the answer, but I would still consider a MRA and MRV first.

Try to relax and talk to your doctor. If you experience more vertigo or balance weakness then seek medical attention.

 

[John3D]

@Greg Sacramento Thanks for your advice, having had a rough few days of neck stiffness I'm more confident that the noise and discomfort is indeed cervicogenic, looking back to it having started during a very stressful time during my final year at university where self care and really anytime away from my desk was at an all time low.

I'll be getting an MRA and MRV soon, I'll probably have to pay out of my own pocket for it but I'm sure it'll be worth it for the peace of mind.

 

[Greg Sacramento]

@Greg Sacramento Thanks for your advice, having had a rough few days of neck stiffness I'm more confident that the noise and discomfort is indeed cervicogenic, looking back to it having started during a very stressful time during my final year at university where self care and really anytime away from my desk was at an all time low.

I'll be getting an MRA and MRV soon, I'll probably have to pay out of my own pocket for it but I'm sure it'll be worth it for the peace of mind.

John: Hopefully you have just a minor cervicogenic issue where nerve and muscle therapy treatment will solve. Those with physical nerve or arteries situations need to be careful with noise especially while resting. If you use pink noise - rain, waterfall or stream while sleeping, keep the volume low. I keep the volume that I use just under 35 decibels. I also use a small soft folded pillow under neck. Please keep me informed.

 

[John3D]

John: Hopefully you have just a minor cervicogenic issue where nerve and muscle therapy treatment will solve. Those with physical nerve or arteries situations need to be careful with noise especially while resting. If you use pink noise - rain, waterfall or stream while sleeping, keep the volume low. I keep the volume that I use just under 35 decibels. I also use a small soft folded pillow under neck. Please keep me informed.

I don't often use noise machines other than a quiet TV as I'm falling asleep, I probably shouldn't ask but do I need to be careful for the sake of not damaging my hearing? Or is there something I should be keeping an eye on?

 

[Duncan L]

Why hasn't your ENT sent you to a neurologist? The problem is very clearly in your C-spine. As it is for virtually everyone with a somatic based tinnitus. It could also be a fistula (blood clot) or stenosis (collapsed vein), however you won't know that until a neurologist gets a high contrast MRI or your brain and C-spine. I'd bet dollars to donuts that you have disc degeneration and osteophytes (bone spurs) in your neck - particularly on the side your PT is. After a neurologist makes an assessment they'll decide whether you should be referred to a neurosurgeon for a more in-depth look at the problems and the solution.

When this sort of thing occurs the foramina is generally impigned by the combination of the collapse of the disc and the bone spur. This causes T as a secondary effect. If it can't be resolved through physical therapy - than surgery is required. Given the length of time you've suffered from the condition it seems more likely than the resolution would be surgical in nature, as somatic based PT generally resolves itself in a 6-18 month time frame on average. There are outliers on that where it can last years but it's rare. So if your audiometry reports are ok and the ENT can't find a problem than the problem isn't your ears and likely never has been.

It wouldn't hurt to see a physiotherapist as well - but only after a determination has been made on your C-spine. Spinal traction and/or inversion can help. And if you find the trapezius - also on the same side as the PT - is in tone - tight/stiff look at massage and dry needling. Osteopathy or chiropractic treatement would also be of benefit.

One of the best comments about tinnitus causation I have ever read - thank you