by Neil Bauman, Ph.D.
A lady asked:
Can unilateral pulsatile tinnitus in my right ear only be the cause of hypertension/high blood pressure? What are the causes unilateral pulsatile tinnitus?
Its the other way around, but yes, high blood pressure can result in pulsatile tinnitus.
There are a good number of causes of pulsatile tinnitus. All of them are vascular—meaning having to do with blood flowing in the various blood vessels near your ears. This is because pulsatile tinnitus sounds are rhythmic, pulsing sounds that are synchronous with your heart beat.
The most common cause of pulsatile tinnitus is benign intracranial hypertension, followed by carotid artery disease, glomus tumors, turbulent blood flow, increased blood flow in different blood vessels, emissary veins, high blood pressure, twisted arteries, aneurysm in an artery, and a number of other things.
If you are interested, you can read more about pulsatile tinnitus (and all the other kinds of tinnitus) in my book, “When Your Ears Ring! Cope With Your Tinnitus—Here’s How“.
Dear Dr. Bauman,
A couple months ago I developed bilateral pulsatile tinnitus. I would hear my heart beat in either ear when I turned my head left or right on the pillow. The only way I wouldn’t hear the sound is when I kept my head/neck completely straight while lying on my back. I also began hearing it while standing at times. The other symptoms I’ve noticed are when I stand up from lying down for awhile, my blood pressure spikes for a moment and I feel dizzy, and occasionally the vision in my right eye gets fuzzy. Admittedly the pulsatile tinnitus began after a period of marked stress in my life which perhaps raised my blood pressure, although my blood pressure reads as normal. Is it possible to have elevated blood pressure in the brain only? In other words can a person with otherwise normal blood pressure (and overall good health) somehow have intracranial hypertension?
As the pulsatile tinnitus is very difficult to tolerate, particularly because it feels like I am out of breath when it’s happening, a cardiologist ordered an ultrasound of my carotid artery which showed the blood was moving at a higher velocity than normal in one part of the artery on my left, indicating a narrowing of that part of the artery, but there was no plaque. She also did an intracranial ultrasound to check the blood flow into my brain, and an echo of my heart, both of which were normal. But due to the carotid artery issue, I am going to have a CT with contrast dye (angiogram of the artery and blood vessels in the neck) which is usually a barium-sulfate solution or iodine solution called Lopamidol or Gadolium. Do you know if any of these chemicals are ototoxic? I was not able to find much information online besides a couple anecdotal reports of patients’ tinnitus getting permanently worse from one instance of dye, and the barium sulfate destroying the hair cells in zebra fish.
Another test, which a neurologist asked me to do, is an MRI without contrast to see if there is something in my brain. If I wear MRI-compatible protective headphones, will my ears most likely be safe from noise damage?
Sincerely,
Steph
Hi Steph:
I’ve not heard of blood pressure spiking after standing up from laying down (but then, I’m not a medical doctor), but I sure have experienced the opposite, orthostatic dizziness from blood pressure dropping when standing up from laying down which also affects vision.
When you hear pulsatile tinnitus by turning your neck, I think the cause is that by twisting your neck, you partially constrict your carotid arteries so the blood has to travel faster and this turbulent blood flow is what you hear as pulsatile tinnitus.
That out of breath feeling indicates that your brain is not getting enough oxygen, probably due to lack of adequate blood flow hence your heart beats faster to try to get more blood to your brain–and the turbulent blood flow is again what you hear as pulsatile tinnitus.
That is Iopamidol, not Lopamidol. The lower case L (l) and the capital I look similar.
Iopamidol is mildly ototoxic. There are a few reports of hearing loss, but I think the risk is very low, so it is probably worth the risk.
The Gadolinium drugs (there’s a whole family of them) are more ototoxic in my opinion (but still relatively low risk), but there are other risks such that they build up in your brain and cause serious problems such as movie star Chuck Norris’ wife experienced. So I’d ask whether they can get what they need in the scans without using Gadolinium. The Gadolinium makes the pictures sharper but it is not actually necessary in many cases, just nicer to have.
If you want the ultimate in safety, wear the foam ear protectors in your ears and then wear the ear muff ear protectors over them. That should be enough protection. Note that this will protect your ears from sound waves in the air, but it won’t do anything for conductive sounds–but it is the best you can do. I doubt if you do this properly, an MRI on your head will bother your ears. Just relax and remain calm. And make sure they don’t play any music through the headphones like they sometimes do as THAT can be too loud. You don’t help by covering up one noise with even louder noise.
Cordially,
Neil
Thanks so much Dr. Bauman. So insightful as always.