Pulsatile Tinnitus due to Orthostatic Hypotension or Vertebrobasilar Insufficiency?

I often get the effect, after sitting down for as short as an hour, of getting up and suddenly feeling like I will pass out. So much blood appears to rush to my head that my hearing goes, my ears and head feel like they are going to explode, and I get the pulsatile tinnitus for a few seconds. I also have these attacks in my sleep.

Tonight was my worst attack and it left me with a bit of low frequency hearing loss, and I don't know if that will happen again.

As a first, I was not diagnosed with OH in my recent checkup and only have low normal blood pressure. The latter possibility has not been ruled out. I am also fairly sedentary and can only do light walking as a form of exercise, which may contribute to what is going on now.


Anyone else with pulsatile tinnitus suffer from either of these conditions? Any help is appreciated, thank you!

 

Hello Karen,

Thank you for your reply and insight.

I am taking a number of medications that lower blood pressure at small doses. My GP did tell me that they had an influence on my current low-normal blood pressure. But she could not formally diagnose me with OH under the tests I took.

I had pulsatile tinnitus and a bunch of ear and head problems (mostly migraines) prior to starting these medications, however, and in hindsight these symptoms do instead resemble vertebro-basilar insufficiency.
I actually believe the problem lies in my neck; there has been a misalignment in my cervical vertebrae for quite some time, especially after a fall 3 months ago which gave me symptoms of a neck strain and weakness throughout my body. In some cases an incorrect alignment in the neck can pinch the vertebro-basilar arteries or other nerves, and can hence directly affect the ears.

To this day, my ear problems are made worse by various head/neck manipulations and the OH symptoms coincidentally don't just arise when I'm standing up too quickly.

 

I don't think I have postural hypertension, but I do know that if I've been laying down for a while and I get up, I will start to hear whooshing in my ear for a few seconds (typically around ten seconds) before the sound goes away. Also, if I'm standing up and I bend over to touch my toes I will hear it.

This didn't happen until after I got regular T.

 

@Coyotesheaven

I don’t know if you’re still monitoring this page. What you described above, is exactly the same symptoms I suffer from.

I’m a high school teacher in Canada, and when I’m sitting at my desk for as little as 5-10 minutes, I experience intense dizziness - almost to the point of fainting. Along with, what seems like pressure in my head, and my ears (I think) are pulsating to the sound of a heartbeat. During these pulses, my hearing goes in and out for brief periods. The whole “attack” lasts about 20-30 seconds. Immediately after I feel a little nausea.

Did you ever get your condition diagnosed? I’m meeting with a new doctor on Tuesday for further exploration.

I should mention that I feel this upon standing up. it’s been getting worse and more noticeable. It’s really scaring me...

 

@Coyotesheaven, I am a pulsatile tinnitus suffer that has orthostatic hypotension. Symptoms are almost always caused by a positional change i.e. getting up from the recliner or chair, getting out of the car after a 30 minute drive. Symptoms include: the sense of pressure in the head which can be quite intense; whooshing that is in sync with my heartbeat; and temporary 30-60 second changes in my hearing in both ears.

I have always thought the symptoms were caused by the hypotension but lately I am not so sure. One day I was extending myself to get a better look in a mirror which sparked an episode. Also, one morning when I got out of the bed, the whooshing started, so I turned my head to the left and down and it stopped immediately.

I have recently been diagnosed with mild to severe cervical degenerative disease. I get a sinking feeling my neck has a hand in my pulsatile tinnitus.

 

Update:

I have been working with the specialist at the University for my orthostatic hypotension. Over the last few months we have made a number of med changes that did seem to have an affect on my pulsatile tinnitus but, 3 weeks ago they added 30 mg x3 of Pyridostigmine to the regiment.

At first I was still having the whooshing episodes but as of late I have only had two and have been when getting out of bed and they are short lived and very mild.

I am hoping this continues to go in the right direction. We did discuss the possibility of upping the dosage; I will find out next week.

 

Hi Mike O! I was wondering if you ever got a firm diagnosis for your condition. What you describe is exactly what I've been dealing with since the end of 2021 but I haven't gotten even close to a proper test, let alone diagnosis. I don't know where to start :-(

 

Are you still having symptoms? I have had pulsatile tinnitus for seven months. Mine is aggravated by movement. When I get out of bed, or a car, for example, my heart beats harder and I feel slight pressure in my head and get a whooshing sound that intensifies before dying down. It sounds something like whoosh whoosh WHOOSH WHOOSH WHOOSH WHOOSH whoosh whoosh whoosh. There is a marked crescendo followed by a decrescendo. It starts to crescendo about 5-10 seconds after my heart starts beating harder, like blood is struggling to get through a vessel or something.

I had an MRI and MRA of my brain that showed high riding jugular bulb and diminutive right vertebral artery. Neither condition is a pathology. However, I think I may suffer from vertebrobasilar insufficiency or some kind of narrowing or blockage of my vertebral artery. I still have no diagnosis.