Pulsatile Tinnitus: 10 Reasons You Hear a Pulse in Your Ear

If you’ve ever been to a concert or sat too close to a loudspeaker, you’ve likely experienced tinnitus, or ringing in your ears, afterward.

Don’t panic. Pulsatile tinnitus is often temporary and harmless, says Oliver Adunka, MD, director of the division of otology/neurotology and cranial base surgery at The Ohio State University Wexner Medical Center in Columbus.

Although it usually isn’t bad to hear your heartbeat in your ears, it can also be the first sign of an underlying (and sometimes serious) health issue, Dr. Adunka says. To be safe, you should always seek medical attention and a proper evaluation if you experience a persistent pulse in your ear.

Here are 10 causes of pulsatile tinnitus.

1. A Strenuous Workout

Anyone who’s ever pushed through a strenuous sweat session has probably heard their heart pump in their ears after the workout. This is very normal, Adunka says.

When you exercise vigorously, your cardiac output increases, briefly boosting how much blood is flowing through your vessels, including those near your ears, he explains. And this temporary rise in blood flow can sometimes produce a pounding sound in your ears.

2. Anemia

With anemia, your blood composition changes — your red blood cell count is low — which can trigger turbulent blood flow in your veins, Adunka says. And this turbulent flow can generate the thumping noise in your ears.

Here’s why: Behind your ears, there are big blood vessels that transport blood from your brain back to your heart. Usually, you can’t hear those vessels, but if the blood flowing through them is forceful (as is the case with people with anemia), you can, Adunka says.

He uses the analogy of a river to illustrate the point: If the water is running smoothly, it’s mostly silent. However, if you have white water, it’s very loud. Due to the altered blood composition, people with anemia essentially have “white water” coursing through their veins.

3. Thyroid Issues

Similarly, thyroid conditions can alter the composition of your blood, Adunka says. And this can sometimes cause fluctuations with blood pressure that can affect the venous return to the heart and produce pulsations in your ears, he explains.

4. Fluid in the Ear or an Ear Infection

People who have fluid in their middle ear, which may or may not be related to an ear infection, often hear their heartbeat. That’s because the blood vessels around the ear will usually pulsate the fluid (which temporarily replaces air) in the middle ear, Adunka says.

5. High Blood Pressure

6. Atherosclerosis

7. Pregnancy

8. Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension — a condition that causes pressure in your brain — can cause a hammering heartbeat noise in your ears as well, Adunka says.

• Vision changes
• Dizziness
• Nausea or vomiting
• Neck stiffness
• Trouble walking
• Frequent headaches
• Forgetfulness
• Depression

9. Paraganglioma

Paragangliomas — rare, neuroendocrine tumors in the head and neck that are typically benign — almost always have pulsatile tinnitus as a symptom, Adunka says.

• Hearing loss
• Earache
• Face, tongue, or shoulder weakness
• Hoarseness
• Trouble swallowing
• Drooping eyelid

10. Arteriovenous Malformation

A blood vessel disorder, such as an arteriovenous malformation (AVM), can also be the basis of a beating sound in your ears, Adunka says.

With an AVM, arteries and veins become intertwined and tangled (the high-pressure system in the arteries gains access to the low-pressure system in the veins), Adunka explains. And it’s this abnormal connection between blood vessels that causes the noise.

• Headache
• Muscle weakness or numbness
• Vision changes
• Trouble speaking
• Changes in sense of smell
• Dizziness
• Seizures
• Facial paralysis
• Pain

If undetected, an AVM can lead to serious complications, such as bleeding in your brain, Adunka says.

Why Pulsatile Tinnitus Gets Worse When Lying Down

This has to do with the sigmoid sinus, a large blood vessel behind your ear that leaves your brain and drains into your jugular vein, Adunka says.

“If you turn your head or hold it in a certain way, you basically change the position of the sigmoid sinus and how much blood is going through that vessel behind your ear,” he says.

For instance, when you push into your neck (right next to your larynx), you can make the vessel smaller. For some people, this can decrease (or increase) the thumping in their ears, Adunka says.

Likewise, when you lie down, especially on your side, you can affect the position of the sigmoid sinus, and this can result in a louder pounding noise.

Plus, you’re more likely to hear your heartbeat in your ears at bedtime because it’s quiet and there are fewer distractions, Adunka adds.

When to See a Doctor for Pulsatile Tinnitus

An incessant thumping in your ears is incredibly irritating and can interfere with your daily life, making it difficult to concentrate or sleep. “People shouldn’t have to live with it,” Adunka says.

While most cases of pulsatile tinnitus are temporary, you should seek medical help if the pounding in your ear persists, especially because it can be a sign of a more serious underlying health issue.

Adunka recommends seeing a neurotologist — a highly specialized ear, nose, and throat doctor — who has more experience than a general practitioner or family physician when it comes to inner ear concerns.

Once you receive a proper medical evaluation and diagnosis, you can treat the problem at the source and put a stop to the pulsing in your ears.

The Takeaway

• Pulsatile tinnitus is a condition that causes you to hear a whooshing or thumping sound in your ears, often with a beat that’s in sync with your heartbeat. The noise can worsen when you’re lying down.
• Pulsatile tinnitus is usually a harmless, temporary condition that may occur after a vigorous workout, if you have fluid in your inner ear or an ear infection, or during pregnancy.
• More serious causes of pulsatile tinnitus include anemia, thyroid conditions, high blood pressure, atherosclerosis, idiopathic intracranial hypertension, paraganglioma, and arteriovenous malformation.
• See a doctor if the pulsing sound is persistent or if it’s interfering with your quality of life. General practitioners can diagnose straightforward issues, such as an ear infection, while a neurotologist can check for other underlying conditions.