Pulsatile Tinnitus That's Not in Sync with Heartbeat and Has Two Different Phases. Causes?

I am trying to help my relative who developed tinnitus couple months ago. The problem is severe, she can't eat sleep or work and has severe anxiety with constant panic attacks. Help is much appreciated...

The tinnitus:
- Alternates between loud and soft every day or so.
- The sound is reminiscent of high pitched noise or waves getting more distant and coming near again. A bit like a "ssshh" sound that modulates.
- The sound does not appear to pulsate with heart beat, it's a bit slower.
- There are two different phases that alternate daily. On the loud phase she has difficult time characterizing the tone, but it's very obnoxious. She uses phrases like "it's inside the head" "right by the ear" and such.
- The tinnitus does not modulate with facial movements.

Her hearing is fine, and there is no known cause, the tinnitus appeared randomly.

What could be the cause? I would expect it's not vascular since the sound is not in sync with the heartbeat, and is more high pitched than I would expect. An ENT told us that tumor would cause hearing issues, which she does not have. We are planning to get an MRI/CT scans done as I think that's the next logical step, but in the meantime if you have any knowledge of possible causes or have suffered from similar symptoms, I would appreciate your opinions very much. The doctors we have visited so far don't know much about pulsatile tinnitus.

 

Thank you Karen.

Now the doctor has told us that scans should not be performed, bad news. It will take couple weeks or so to get a new appointment.

In the meantime, if anyone has ideas what could cause this kind of tinnitus I am all ears! The tinnitus is still alternating between faint and so loud that it causes a panic attacks, which means that she is still unable to work. I am not sure if the tinnitus is even pulsatile as it isn't in sync with the beat.

Feels to me like there should be a cause for such large variations in the tinnitus.

To answer your question, she hasn't taken any medication, doesn't have blood pressure issues, isn't overweight. No jaw issues that I know of, but I can't rule that out. The only thing that I can gather that is out of the ordinary is that she has always been anxious, with the tinnitus the situation is much worse with that.

 

To stay calm she is on anti-depressants and a few different anxiety medications. She still has problems relaxing and sleeping.

The doctors unfortunately don't generally know much about tinnitus. That's why I am asking opinions here in case someone has had similar tinnitus or knows a specialist that knows about the different conditions.

She hasn't had an ultrasound.