by Neil Bauman, Ph.D.
A lady explained:
I have developed pulsatile tinnitus in my left ear which is progressing in severity. I have also been having ear pain at times in the left ear. I have seen an ENT and a doctor of audiology in the last month. Both seem to think the pulsatile tinnitus is just something I have to live with and have had no further recommendations (the doctor of audiology didn’t even examine the ear). I am considering going to my local University or the Mayo clinic for another opinion to make sure there is not something else going on. Am I being just a little paranoid, or should I be investigating further?
First, you need to be aware that doctors of audiology (Au.D.) are not medical doctors and thus are not trained to examine ears (in the medical sense). Thus don’t feel slighted that your audiologist didn’t do so. This is not their area of expertise. They are trained in evaluating hearing, not diagnosing medical problems. Your ENT is the medical doctor specializing in problems of the ears, nose and throat, and thus is the one who can give you a proper examination.
Second, before I answer your question, let me explain a bit about pulsatile tinnitus, and what it sounds like. Pulsatile tinnitus sounds are tinnitus sounds that are synchronous with your heartbeat. Thus, pulsatile tinnitus is generally related somehow to the blood flowing in the blood vessels in your neck and head—close enough to your ears that you can hear them.
Although pulsatile tinnitus sounds are rhythmic pulsing sounds in time with your heart beat, they have a number of variations. For example, they may be drumming, beating, pounding, throbbing, pulsating or fluttering sounds. They may have single beats, or they may have biphasic beats (like the clip-clop of a horse). They may even make swishing, swooshing or whooshing sounds (to name some of them).
Here are some of the more common causes of pulsatile tinnitus. You may have what is called a glomus tumor. Glomus tumors occur in about 12% of diagnosed cases of pulsatile tinnitus. A glomus tumor is a non-cancerous mass of intertwined blood vessels growing near your ear. The blood pulsating through them could be causing your pulsatile tinnitus.
If you had a glomus tumor, perhaps it could also be pressing on something causing your pain. I don’t have a clue, of course—but a good ENT doctor (not all are good as you have found out) or a good vascular surgeon should be able to figure out what is going on, and whether it needs further investigation or treatment or not.
Another common cause of pulsatile tinnitus is “Benign Intracranial Hypertension” syndrome or BIH. BIH accounts for about 39% of all diagnosed cases of pulsatile tinnitus. BIH is increased pressure of the fluid that bathes your brain. This syndrome includes headaches and blurred vision among other things.
Pulsatile tinnitus could also be the result of Carotid Artery Disease (CAD) which accounts for 17% of all diagnosed cases of pulsatile tinnitus. With CAD, the “gunk” in your arteries (to use a fancy medical term—which is sure easier to spell than “atherosclerotic build-up of cholesterol”) reduces the space inside the arteries in your neck leading to turbulent blood flow which you hear as pulsatile tinnitus.
High blood pressure, which makes the blood flow faster and thus produce more noise, is yet another cause of pulsatile tinnitus.
These are just 4 of the 25 or so known causes of pulsatile tinnitus. A good doctor will investigate and rule out all of these before he says “live with it.”
Pulsatile tinnitus is typically a vascular (blood vessel) problem. Thus, quite often doctors can help it by surgery or other treatments.
Since your ENT basically brushed you off, by all means, get a second opinion. You are not being paranoid. You are simply taking charge of your ear problem, and that is good. After all, it is you who have to live with it, not your doctor.
To learn more about tinnitus in general and pulsatile tinnitus in particular, you would do well to read the book “When Your Ears Ring—Cope with Your Tinnitus—Here’s How“.