Pulsatile Tinnitus That Cycles Every Few Seconds?

Hey,

In May 2019 I heard my pulse whooshing in my right ear for a few weeks. Back then I didn't really care and it mostly went away. However, since a few days it's been back and due to the ongoing lockdown I really freaked out about it.

It is a rhythmic thump/whoosh, exactly in sync with my pulse. It has a cycle time, it is absent for 30 seconds or so, then appears, gets louder, reaches a peak, fades out (all in roughly 30 seconds), then it's quiet again.

During the day it's mostly inaudible, but it's disturbing at night and interferes with my sleep.

I've visited an ENT. He immediately performed a blood pressure measurement on me, it's 160/85 with a pulse of 91. One measurement is not enough for a diagnosis but it sure seems like I have hypertension. The ENT says that's the cause of the trouble.
I've also scheduled an appointment with a neuroradiologist and will ask him to perform an MRA on me, just to clear any suspicion of blood vessel abnormalities.

Questions:
* Do you think hypertension is a good explanation here?
* Does anybody have thoughts on why the thumping would have this on-off cycle? I can't think of any bodily process that cycles every 30 seconds.
* I'm a bit panicked. Does anybody have reassuring words? I'm an old hand when it comes to regular tinnitus but pulsatile is a whole new arena for me.

Thanks!

 

You're doing the right thing.

1. Hypertension can be a factor, but that solely usually isn't the issue.

2. The intermittent nature is normal for pulsatile tinnitus. This is how it almost always presents.

3. Don't panic. You're dong the right thing by having it investigated. The times it becomes dangerous is when people ignore their symptoms and don't get it checked out, and leave it for a long time to develop into something worse. Also, after having it investigated, even if there is an issue, the surgery to correct it is relatively low risk and minimally invasive, with a quick recovery.

Have you read my thread on this topic?

 

Do you think it can go away by treating the hypertension? It did go away for more than a year previously.

Yes, I read your thread - that is how I chose the specialist to see. My guy is a neuroradiologist + neurointerventionalist combo. Thank you for your thread and your support in the Pulsatile Tinnitus subforum!

 

It really depends on the underlying cause. If it's something like DAVF, it won't get better. Having lower blood pressure is always better though.

 

Wanted to ask - what do you mean by "intermittent"? The fact that mine pulses 30 seconds on/30 seconds off, or that it went away for more than a year then came back? Frustratingly, I couldn't find many patient reports which contained this detail.

 

Hey @hans799, I have experienced EXACTLY the same scenario this year but in my left ear. It went away for a few weeks then came back again, and then went away. I'm not concerned at all about it.

I was a bit bunged up and it was going on in the middle of lockdown too. Personally I think this year has been so extraordinary in terms of what has been going on with Covid etc that many of us are actually a heck of a lot more stressed out than we realise. And as we know, stress levels are a major factor in these conditions we live with.

I think you're doing the right thing seeing the doctor though, and putting your mind at rest. BTW - glad to hear that your tinnitus has gone back to pre-Lenire baseline. Good news!

 

You're so right, man. I looked back in my journal and last year when this came on for the first time all I did was make a note saying "I seem to have pulsatile tinnitus", and then another note a few weeks later saying "that thing went away". Zero reaction.

Then last week I was already in the dumps with a major breakup, a painful change in my social circle, and Hungary's second COVID-19 wave hitting like 3 days of each other. Aaaand then this shit again! Probably explains why I'm freaking out so badly. I'm doing my best to be a strong, resilient man, but could the universe please give all of us a break, for God's sake?!

Yeah, I'm really happy about that. You know what? I'll take a mild bout of pulsatile tinnitus any day over a serious "classic tinnitus" spike. At least pulsatile is supposed to be diagnosable and treatable.

Thanks for replying to this thread and letting me vent, whew this felt great.

 

The ENT who measured the 160/85 blood pressure referred me back to a GP for further evaluation. I went yesterday. I've been measuring my blood pressure at home using an Omron M2 device, and the GP also measured it 3 times in her office, and all of the systolic readings were around 135-140. So the GP says I don't have hypertension. My blood pressure definitely is elevated, but it doesn't require medication. I'll be doing a lot of cardio, though (which I've completely neglected for years).

The pulsatile tinnitus is still there, still doing its on-off thing. Its volume does change, sometimes it's a lot softer. Maybe that has to do with blood pressure? Anyway, I'm glad that it's not worsening.

My sleep is still affected. I'm using 600mg valerian root to help me drift off, and I get 5-6 hours a night with several wakeups. It's not very great, but not that terrible either.

Psychologically I'm doing better, that horrible initial panic has subsided. Even if everything stays like this, I'll still have a life very much worth living. Although I do expect some worse days ahead.

My only real fear is that it gets significantly worse, or that it has a malicious cause. One of my grandmothers died of cerebral hemorrhage. I hope that the neuro-interventional radiologist I'll see next week can clear these fears up. If the MRA and angiography and other tests come back clean, I can expect the thing to be benign and stay stable, right?

 

I just had my appointment with the neurointerventional radiologist. He sent me for an MRI and an MRA, with the appointment in roughly 2 weeks. He's also very experienced with cerebral angiograms, but first the MR.

The last couple of nights were fairly good, I could sleep without valerian. I do drink a fair amount of wine, though. Alcohol takes my mind off pulsatile tinnitus, normal tinnitus, coronavirus, economic crisis. Alcohol is a good friend of mine.

 

Damn thing is 95% gone. I've now had 7 nights in a row when it was either very easy to ignore or completely absent. The bad part lasted roughly 2 weeks, exactly like back in May 2019.

On one hand I'm happy, of course. On the other hand I'm worried that I never got to the bottom of this.

Before both episodes, I've slept on incredibly uncomfortable beds which caused bad neck pain lasting at least 2 days. My best bet is that this compressed some muscle or blood vessel or whatever, and that was causing the sound. Exacerbated by the high blood pressure I have.

I'm somewhat grateful because investigating this issue revealed that I have high blood pressure. Also, I bought really comfy new mattresses. Hope that good sleeping posture and plenty of cardio will be enough to keep my blood vessels in good condition, and this god damned pulsatile tinnitus will stay away. My permanent neuro-tinnitus is perfectly enough to live with, thank you.

 

I have this but have nausea and head pain, left ear, cycles every 30 seconds really awful, awaiting MRI.

 

For pulsatile tinnitus is it common to get "stuck" on one sound?

What I think is pulsatile tinnitus, was beeping today at me what felt like every 4 seconds for a bit, but it got stuck on beeping several times and just played that one high-pitched sound. I am still in the process of getting it checked out, but hopefully my psychiatrist I saw today should be able to help, as she did say she was going to strongly recommend to my GP to give me the referral I want...

 

Update: I got a head/neck MRA and a neurointerventional radiologist looked at it and said it's completely clear.

The initial bad bout of this pulsatile tinnitus cleared up in roughly 2 weeks. I suspected that it's posture-related so I swapped my shitty old uncomfortable bed mattress and pillow for quality ones; I believe that had a big role.

It's not completely gone because sometimes it comes back, but much quieter, and with much longer pauses between episodes (it used to be 30 seconds off, 30 seconds on; now it is 3-5-10 minutes off, 10-20 seconds on, and often totally gone for days). I'm now beginning to work on my posture during the day. I spend a LOT of time huddled in front of my laptop or phone and that's probably screwing something up in my neck. Thinking about getting an adjustable standing desk for my home office, and maybe also a posture corrector.

 

I was diagnosed with a dilated jugular vein. Could this be the cause of my throbbing sinusitis? In addition, I have osteochondrosis

 

@hans799 for your blood pressure, if you can afford it I’d get a home BP monitor. I regularly get reads in clinical settings that are much higher than at home. I also find that many doctors don’t set up a great condition for a resting read. Ideally you want to be calm, in a quiet room, and just sit there for about 5 minutes prior to the read. I find most doctors ask you a bunch of stress provoking questions about your condition and then immediately take a reading - which is not going to set you up for success.

I even had an ambulatory BP monitor that took my reading every 15 minutes for 24 hours. My reading were great - even during the day while I was working a somewhat high stress job. ...but stick me in a doctors office and I always read high.

At home I can control the conditions when I take a reading and make sure I have the time to relax for a couple minutes prior. Also you can get average AM readings which are particularly important.

Anyway - just sharing this as having one at home helped me quite a bit. They aren’t that expensive (under $100 anyway).

 

Hello new member here and I am glad to find an active forum speaking just to PULSATILE tinnitus. I have had it since May 2020. Left ear only. It definitely cycles with volume level changes about every 60 seconds but sometimes is much more consistently always loud. I have also experienced very quiet periods, the inconsistency of this thing is the most bizarre aspect of it. It’s very bothersome but I’m handling it pretty well since I have had several tests and they haven’t found anything wrong. Of course this is both good and bad. I’ve had the cerebral angiogram and it was clean as well as the other scans and image tests. I also had all 4 wisdom teeth out just in case that was the cause but nope. The only thing that changed in my life when this began is that I had stopped playing hockey 2 months prior due to lockdown. I think there is a link between vigorous exercise getting heart rate over 150 beats per minute ( not walking around the block) and PT since it really gets the blood flowing and opens up all the circulatory pathways. Further evidence to me was when hockey reopened in September, I played for 4 weeks and it went away and was gone totally for a month, I had a lovely October! Then they shut hockey down again and it came back again mid November and I have had it since.


Has anyone else found anything to turn it on or off or a link with periods of vigorous exercise?

 

After that initial episode of 2 weeks back in September, the pulsatile tinnitus only came back maybe twice for 1-2 days, but it was almost completely absent for 4 months. It's definitely back again, though. Not on full blast (instead of 30 seconds on - 30 seconds off, I get 20-30 seconds on - 2-5 minutes off), but the same phenomenon.

On Saturday I somehow slept in a bad posture and strained a muscle (I think the levator scapulae) in the right of my neck, then in my infinite wisdom I decided to do pushups without warming up and pulled the same neck muscle even worse, and it hurts so much I couldn't turn my head yesterday all day long. This is the exact same spot that I've strained before I got the September 2020 episode and the May 2019 episode, too.

So I'm getting fairly certain that my pulsatile tinnitus is induced by strained and tight neck muscles constricting some blood vessel. My physiotherapist says this is definitely possible (in fact her brother had pulsatile tinnitus of similar origin), while I had a head+neck MRA taken in October, which was declared completely clean by an interventional neuroradiologist, so it doesn't seem to be arterial in origin.

Not super happy to be back in pulsatile-ville but I'm reasonably certain that it'll clear up in at most 2 weeks like it did the last 2 times.

 

What is the surgery called?

 

High blood pressure (hypertension) is an important risk factor for atherosclerosis, the development of unstable carotid plaques. High blood pressure can cause carotid atherosclerosis.

Blood Pressure and the Progression of Carotid Atherosclerosis in Middle-Aged Men | Hypertension (ahajournals.org)

Dr. Howard Weintraub, a cardiologist at NYU Langone Medical Center, says that once you’re diagnosed with atherosclerosis, the most you can do is make the disease less dangerous.

He also explains that “in the studies that have been done so far, the amount of reduction in plaque buildup that’s seen over the course of a year or two is measured in a 100th of a millimeter.”

Medical treatment combined with lifestyle and dietary changes can be used to keep atherosclerosis from getting worse, but they aren’t able to reverse the disease.

 

There isn't any one name or specific procedure. The intervention performed is very dynamic and specific to the situation. Most times it's endovascular, meaning done through the blood vessels with a catheter, so it's minimally invasive. But use of different embolic materials, stents, platinum coils, etc., can be used to treat the issue. In my case, I've had platinum coils, a nickel titanium stent, onyx, and nbca embolic materials used.