2 Months of Pulsatile Tinnitus & 10 Years of Tinnitus

Hello, I’m new here. It’s my first post. I’ve had tinnitus for 10 years and when I was first diagnosed my ENT told to just live with it. No other advice was given to me and I did learn to cope with it. But now I have been dealing with pulsatile tinnitus for 2 months and I’m feeling overwhelmed and scared. My PT is 24/7.

When my PT first started I thought it was anxiety because I had been under a lot of stress for the last 6 months.

I can hear my heartbeat so loud and feel the vibration, sometimes the vibration goes all the way down to my feet. The sounds are usually of my heart beating and the worst ones are the revving sound of a car engine and they last from 20-30 minutes. 2 nights ago I took 7.5 mg Mirtazapine for sleep and anxiety. It knocked me out and slept for 7 hours straight, but woken up by heart palpitation that lasted for about 30 minutes and had the heart palpitation off & on for the rest of the day. At night I took 3.5mg of Mirtazapine to help me sleep but woke up 2 hours later with heart palpitation. I was able to calm my heart palpitation down, but every hour I would get the heart palpitation throughout the day. The heart palpitation was caused by the Mirtazapine. I decided not to take Mirtazapine last night and and slept for about 2 hours and would fall asleep off & on but every hour my PT would become so loud and feel vibration that it would wake me up. I feel so hopeless.
I have severe hearing loss and wear hearing aids on both ears.

Does anyone else feel their PT vibrate in their body? How do you cope with the vibration?

Can you have TMJ without pain?

I will be seeing an ENT tomorrow and don’t know what to ask him.

I need all the help I can get. Sorry for the long post.

Thanking you in advance.

Marie

 

Tinnitus and PT are completely separate and have different causes. Mine indicated a life threatening issue. An ENT might not be able to detect what the cause is. Please see this thread I created:

https://www.tinnitustalk.com/thread...d-to-do-to-get-answers-and-a-diagnosis.36645/

Also, this site, made by exceptional neurosurgeons on the topic:

http://neuroangio.org/diagnosis-and-treatment-of-pulsatile-tinnitus/

 

Some factors - Age and if you smoke to know if arteries are being blocked causing artery and vein disease anywhere from head to toe. Peripheral arterial disease (PAD) primarily results from atherosclerosis or cholesterol deposition in the walls of arteries that leads to reduced blood flow to the limbs. This can reflect in Carotid BP change.

Do you have any abdominal discomfort or vision problems?
Heart palpitation can be caused by Mirtazapine or other meds.


Quick sudden and brief moments of rising blood pressure hypertension (hypertension moments or hypertension crisis - a medical term) could be cause and that may associate to heart and affect the abdominal aortic vessel if over age 58.
Blood pressure studies may be needed.
Angiography or arteriography may be needed to visualize the inside, or lumen, of blood vessels and organs of the body - including the neck. Ultrasounds of the Carotids sometimes is used as a starting point.
A complete heart ECHO exam from heart to neck.

When one has tinnitus, the stress anxiety from this can cause hypertension blood pressure/hypertension moments and then pulsatile tinnitus can develop - vascular.

 

I have pulsatile tinnitus due to a blocked artery. Pulsatile tinnitus can often be fixed.

 

@Greg Sacramento & @tiniturtle

Sorry for the delayed reply. These fast few months haven’t been good to me. Still trying to figure out how to handle this nightmare. I truly appreciate everyone’s help and guiding me in this journey.

@Greg Sacramento
I’m 54 yrs old female, non smoker and drink occasionally, maybe one or two glasses of wine a year. I don’t have high blood pressure, but found out that my cholesterol was high 10.10. My doctor put me on 5mg of Crestor last month and my cholesterol has gone down to 6.6.

I used to get diarrhea at least once a month, but not now. The Crestor side effect is constipation, sorry too much information. My right eye is a bit blurry.

I just had an ultrasound done on my neck (Carotid Doppler) I will be having a CT Scan on my head on Monday, but scared of it. I was wondering if it’s better to have MRI done on both my ears first? What is best option for less radiation exposure or Scans are a must.

I live in Vancouver, British Columbia Canada

Do you know of NIR or all specialist that would help me with my case in my area.

Wishing you guys a great weekend!

Best regards,

Marie

 

@tiniturtle

Thank you for the detailed informations. I’m slowly learning about PT and having it makes it harder for me to focus and read as much as I can about it.

Best regards,

Marie

 

There are some very good NIR in Vancouver, I believe. I will take a look.

 

@MissM Not too much more in additional thoughts from my post above.
I asked you if you had any vision problems and you just answered with right eye is a bit blurry.

One can have normal blood pressure 99.999999% of the time. Just a single sudden and brief major rise in blood pressure called a hypertension moment or crisis due to a stress event can cause one eye to become blurry with a carotid artery BP reaction.

There may be nothing wrong with your carotids, as they may be just a receiver of heart or other organ input. An ECHO heart exam from heart to neck may be something to consider, since Mirtazapine caused heart palpitations. Your heart is probably fine, but even brief blood pressure changes, even as you sleep - could be your problem. All of this, including the carotids can cause one's eye to become blurry especially if one has atherosclerosis. I would see an ophthalmologist to examine your retina and if needed, a 30 second laser treatment will bring vision back to normal. One dose of Acetazolamide would also help with blurry vision if a single brief hypertension moment (rising blood pressure) was cause.

"I can hear my heartbeat so loud and feel the vibration, sometimes the vibration goes all the way down to my feet." Even leg and foot artery disease (PAD) caused from blood clotting - high cholesterol can refer blood flow up all the way up to the carotid arteries when one is over 50 years of age.

You will need a brain scan to check ventricles and extra-axial CAF spaces to see if they are diffusely enlarged secondary to parenchymal volume loss. Mild hypo density may be noted in the periventricular and to see if subcortical white matter is present. White matter may relate to microvascular ischemic change and is often found with those with tinnitus and pulsatile tinnitus. This is not a big deal, but this will tell if a hypertension moment, not a stroke is cause and cause of blurry vision. A CT Head - syncope w/o con will show all of this, including axial images from the skull base to the vertex. Coronal reformat is also achieved with a CT Head exam. Radiation dose: CTDI (mGy: DLF (mGy/cm) would be 0.28, 43.67; 784. This is not much to worry about as having just one single exam. So this Head CT or a MRI would be anywhere from 66% to 100% effective. Having contrast is somewhat better. so is a MRA, but with tinnitus - and your concerns - it's a hard choice.

 

@tiniturtle , thanks so much!

 

@Greg Sacramento , thank you, you guys are heaven sent. I’m glad I found this site. Pls let me know if they are other tests that I should be looking at.

I forgot to mentioned that I used to grind my teeth and I’m not sure if I’m still grinding my teeth as I haven’t seen a dentist in about 2 years as I’m scared of them. I also broke a couple of the back tooth (molars?) on the upper left side about 4 years ago. The silver filling split in half. I will be seeing a dentist in June or sooner when I find one that deals with patient with PT/T.

Best regards,

Marie

 

I couldn't find a whole lot, since I'm in the states, but I would look into UBC and I think Vancouver general is good too. Try to look for reviews and metrics of neurosurgery departments. Also, one of the best surgeons I saw gave me the advice that it matters more the doctor you go to, than the hospital. I first went to one of the best hospitals in the country here, and they didn't do such a good job with me, and I went elsewhere, which was much better. But in general, city/university hospitals are generally better. Also look for a hospital that has a dedicated cerebrovascular department.

 

@tiniturtle , thanks again you’ve helped a lot. I will check them out

 

@MissM
Hi Marie, did you get a head CT on Monday?

greg

 

@Greg Sacramento
Hi, yes I did and they did not find any aneurysm or bloodclot. To be honest I don’t even know what the doctors were looking for. I think they were more concerned about aneurysm. The ultrasound on the neck also come back negative. I don’t know what questions to ask the doctors? The new doctor I’m seeing told me that it’s just something that I have to live it. I’m suffering, the noise is so loud and it vibrates. I’ve seen my audiologist yesterday and he suggested CBT and TRT to help me. At night my head feels like it’s having a rock concert. I’m still waiting for the MRI on both of my ears to be done.

My anxiety is really bad and maybe I might have ptsd. This is scaring me. It’s torture.

For over a month I was taking Lipitor for high cholesterol and started being sensitive to all kinds of noise. I stop taking it a couple days ago and the hyperacusis went away. I’m 98-100 pounds 4’9”

Am I missing other tests that I could take?

Does anyone have suggestions on anxiety medication that I could take? Mirtazapine gave me heart palpitation.

Kind regards,

Marie

 

MRA is very important. MRI and CT will not show specifics of blood vessels. You shouldn't settle for this answer. See an NIR, and get your answer from them.

 

@tiniturtle Thank you. I will see if I can find a doctor that will take me seriously.

 

@MissM
I was contacted by a poster a short time back and we went from private messages to email. This person was seen by three of the best Neuro Interventional And Diagnostic Radiologists. A complete radiological work up was done, but all radiologists disagreed with each other on scans. This does happen.

There's many specialties within Neuro Radiology, so different specialists may need to be seen, Also many different tests may be needed for different concerns with notation by other radiologists and specialists.

Most of your complaints seem to associate to anxiety. Anxiety causing very brief hypertense moments can cause atherosclerosis, heart, aortic vessel, PAD and vision concerns. All this could then be directed to the carotids arteries. Sometimes this can cause carotid artery stenosis or affect other arteries and veins of neck and cause pressure headaches. The carotid can also cause vision concerns.

With having all of your same issues, I saw a neuro ophthalmologist after MRAs with notation from NIDR. I had complete heart ECHO and examination of aortic vessel ordered by my GP. Ultrasounds of legs for blood clots. Complete blood work.

I do have all your problems caused from anxiety and brief moments of hypertension and I did what I describe above. My neck veins and arteries including carotids are just receivers with little narrowing, but about 40-60% have a carotid problem. I have an abdominal aortic aneurysm and heart problem that interferes w/BP thru my carotid arteries causing all my PT sounds. I think that the chance of you having an aortic aneurysm from hypertension without abdominal and back pain is probably zero. Your problem may relate to atherosclerosis with brief BP change with maybe carotid involvement.

I would discuss hypertension anxiety meds with your doctor.
I read several articles where COVID-19 caused some body vibrations (feeling blood rushing thru body) - carotid or vertebral or internal jugular concerns.

 

@Greg Sacramento
Sorry what is NIDR?
Just saw an eye doctor today and he told me that my eyes are healthy except for dry eye

it’s interesting to read about the Covid causing those symptoms.

Thanks again

 

NIR - Neuro Interventional Radiologist.

Your symptoms aren't anxiety related. Symptoms caused by anxiety should be a diagnosis by exclusion, meaning all things need to be investigated first. Do not dismiss your symptoms or allow anyone else to. That shouldn't event be considered until your symptoms are fully investigated. That's dangerous and irresponsible.

 

@tiniturtle I agree with you, but the doctors that I’m seeing don’t think it’s urgent. I have a phone appointment tomorrow with a new doctor and hoping that she will help me find a cause. Would I be able to email you? I need advise on how to deal with or talk with the doctors so that they will take me seriously

 

@MissM Don't know what your doctors are thinking, but they may feel that it's just anxiety and that meds are needed such as Furosemide. They should explore more by complete workups. I would request a Neuro Interventional Radiologist. If you do have anxiety, then that should be considered as to what possible vascular conditions may need more focus and examination. Brain scans are also needed. I still have association with some of the top neuro interventional radiologists within my area whom I once worked under. If you would like some names in your area, I could get a list from them, otherwise I wish you well.

Radiologists within the level 1 trauma ER where I worked, often considered this along with other possible underlaying vascular concerns when they felt that hypertension and anxiety stress was considerable. This is hard to place in validity context because 60% of these with PT also have anxiety/hypertension blood flow.

"A hypertensive crisis is a severe increase in blood pressure. Extremely high blood pressure — a top number (systolic pressure) of 180 millimeters of mercury (mm Hg) or higher or a bottom number (diastolic pressure) of 120 mm Hg or higher — can damage blood vessels. The blood vessels become inflamed and may leak fluid or blood. As a result, the heart may not be able to pump blood effectively."

Anxiety can cause a hypertensive crisis or moment - sudden and often brief - maybe just one episode or rare episodes where blood vessels become inflamed could make any underlying vascular condition such as with atherosclerotic disease more announced where then sounds are heard. This can happen to older people and often more so with females and we saw this often in the ER.
https://www.mayoclinic.org/diseases...pert-answers/hypertensive-crisis/faq-20058491

"the majority of patients with venous PT were female.[6,8,14] Similarly, in our study, venous PT was found more frequently in female subjects (215, 88.8%). This characteristic is likely associated with benign intracranial hypertension, which is common in women and can present with PT as the only symptom.[8,29,30] "
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834766/

http://www.dizziness-and-balance.com/disorders/hearing/tinnitus/pulsatile.html

 

@Greg Sacramento

Yes pls, if you could send me a list of interventional radiologists in my area. I live in Vancouver British Columbia, Canada. Im learning so much from you and the other members on this site. I truly appreciate you all. Pls let me know if you need my email address.

Thank you❤️

Marie

 

@MissM Hi Marie, Several days ago, I asked a Neuro Interventional Radiologist about a few things that you posted.

I've been writing my postings to you based on his thoughts. He don't know what is causing your sounds, but the below quote is almost his words. He said that's my cause and as you once knew, we see this often. All veins and arteries in neck also need examination.

Have you had a heart ECHO? He just told me that you may want to consult with Jacqueline Saw MD @ Vancouver Hospital. Do you monitor your BP and pulse? Had you had pulse studies?

https://scadalliance.org/board/jacqueline-saw-m-d/

 

@Greg Sacramento I had ECG done. Is that the same as Heart Echo? No, not the BP I will buy a BP monitor and will start monitoring it. When should I check for these? BP & Pulse? Sometimes I check my pulse when the sounds is overwhelming and my pulse would be high as well, but there are times that my pulse is not high. Where can I get the pulse study done or who do I ask?

 

@Greg Sacramento
Do you know about this procedure?
https://www.cbc.ca/news/technology/consider-anxiety-in-ordering-heart-tests-study-1.936300

 

@MissM Marie, contact doctor Saw and tell her that I can hear my heartbeat so loud and feel the vibration, sometimes the vibration goes all the way down to my feet. The sounds are usually of my heart beating and the worst ones are the revving sound of a car engine and they last from 20-30 minutes. This is probably just from peripheral - so don't worry.

Doctor Saw and her interventional associates are one of the better vascular teams in West North America.
She had training at the Cleveland Clinic, which encompassed carotid, peripheral and structural interventional training. Her associates cover all vascular concerns. Many of her publications discuss hypertension, peripheral and the carotid arteries. Pulsatile Tinnitus.

Not saying that anxiety caused your PT directly, but possible association to making a vascular concern more announced. Importance may be or not about stress levels the day that you first heard PT. A hypertension crisis may have never happened. Pulse changes should be check out. Not saying that you have intercranial hypertension (low weight) which should not be confused with other forms of hypertension. So much that would not be known by our discussion.

Family history - parents, other older blood relatives may need to be considered - thyroid, anemia. As far as Mirtazapine, there's many case studies to what you describe.

Do you think that your severe tinnitus was caused by noise? That 's would be understandable to having stress.
Stress over many years can contribute to atherosclerosis which can then cause pulsatile tinnitus. Atherosclerosis and all associated biology and conditions can also cause tinnitus.

Most importance is having a interventional team that cares to help you and that would exclude most doctors.

Just saw your post above, Yes, I have read the complete study. How is your handwriting?

 

@MissM @Greg Sacramento

I've had two of my procedures at Cleveland Clinic and two at NYU Langone. The doctors at NYU Langone are exceptional and maintain that neuroangio site I linked you to. That is very solid information. As far as Cleveland Clinic, I don't want to leave my experiences on a public forum.

You can direct message me here if you like. It's the "start a conversation" option.

 

@Greg Sacramento

We do have stroke history in our family, my grandad and uncle from father side. Dad and mom have high blood pressure. My dad told me that he just started having high cholesterol just for about 4 years, don’t know about mom. I’ve had high cholesterol years ago but because I was going to the gym and didn’t use medication. Only checked cholesterol again this year because of what’s is going on with me at the moment.

How do you test for anemia?

I’m not sure how I got the tinnitus? I used to go to the clubs, listening to live bands.


My handwriting seems fine. Sometimes it looks like I scribble.

 

@Greg Sacramento How do I send screenshots of my lab test results

 

@Greg Sacramento,@tiniturtle

Looking back I realized that I’ve had calves pain on the left side of my legs and thighs prior, and sometimes both legs prior to me having the pt sounds and vibration. Could it be that I have PAD and PT? I find that after I go for a walk I get the pain in my left calve. I think I get more on the left leg. Also at night the calve pain is worst. I don’t understand why the doctors here are not concern as soon they hear that I have anxiety.