Why Would Pushing on Side of Head Quiet My Pulsatile Tinnitus??

Hi all, been a couple of years since I posted. I'll post my story again below so you can get a bit of a background.

Long story short, however, I've been "living with" pulsatile tinnitus now since August of 2017. Started one day abruptly with high-pitched buzzing, sometimes quieter than other times, sometimes I don't notice it but I can always find it if I try. I guess that's part of the habituation process. Anyway, out of the blue last night I pushed the side of my head a bit forcefully for some reason (can't remember why, LOL!) and my pulsatile tinnitus quieted considerably. The pulsing went away and so did much of the high-pitched buzzing.

So I started experimenting and if I push with some effort with my palm anywhere from just above my ear upwards to right where my skull starts curving at the top, it quiets down. Has to be in the area from just behind to above my ear straight up, and not going to far from that line by a couple of inches. Hard to say if the high-pitched buzzing disappears completely, but at least the loud pulsing portion does. If I push similarly on my temple area, no change. Maybe even louder? As with many, I can modulate the intensity of the sound by jutting my jaw forward, looking straight up, etc.

My ENT (read below) says I have tinnitus caused by hearing loss, and it's interacting with forceful heartbeat. Very baffling. all the veins/arteries in that portion of the head are superficial.

Here's my (old) story:

I saw the audiologist for a hearing test yesterday morning and I do have hearing loss in the high frequency range (probably due to either age or some previous exposure to loud sounds, plus I'm from a very poor, rural area and I had a ton of untreated ear infections as a kid). So then I saw the ENT and he examined me, listened to my neck and around my ears, checked for bruits and objective vs. subjective. Said he couldn't hear any problems anywhere. We went through my medical records and did a thorough history.

After hearing my description about how my pulsatile tinnitus can switch between pulsatile tinnitus and regular tinnitus (albeit infrequently), go from left ear to both (albeit infrequently), and go away altogether for a portion of the day, he didn't feel the need for any imaging tests. In his opinion, if it was one of those rare cases of something curable or even more rare cases of something dangerous, it would be less intermittent and also louder.

He said my lower range hearing was still excellent but with my higher frequency hearing loss, my brain was reproducing that sound for me because it missed hearing it so much (haha, I'm paraphrasing there). I've always been able to sense and feel/hear by heart rate throughout my body, particularly in my left ear for some reason. I have a very hard heart beat due to the amount of exercise I do (ejection fraction close to 70% from left ventricle). So as he put all my medical records together as one, basically what he came up with is that my brain is producing the high pitch (which comes and goes) and that's sort of "mixing" with my hard heart beat through either my jugular or carotid next to my ears (but especially with my left). Since I'm still have excellent hearing in that lower frequency range, that's why I'm having a mixture of pulsatile tinnitus, tinnitus and nothing. Venous hum he thought.

 

@gmcmanus66

ENT is correct.

• Categories of anomalies of Jugular bulb (from Park et al, 2015).
  • High Jugular bulb (HJB)
  • Jugular bulb diverticulum (JBD)
  • Inner ear adjacent jugular bulb (IAJB)
  • Jugular bulb related inner ear dehiscence (JBID)

The jugular bulb is a venous structure, that can be located close to the inner ear.The jugular bulb is not present at birth, but develops over time. The size and location is somewhat dependent on pneumatization of the mastoid bone. (Friedman et al, 2009).

An abberent jugular bulb can cause a venous tinnitus. A high-riding jugular bulb is a common vascular anomaly, found in 2.4-7% of temporal bones. About 5 fold higher prevalence of high-jugular bulb is reported in patients with ear related symptoms -- Sayit et al reported 22% in 730 patients presenting to otolaryngology (2016).

Another variant of the high jugular bulb is a jugular bulb diverticulum - -an outpouching of the jugular bulb - -into the inner or middle ear. Most commonly the outpouching is into the middle ear. This occurs in 6% of the otherwise normal population. Sayit et al (2016) reported them in 26 of 730 patients in the otolaryngology clinic, roughly 5%.

According to Kupfer et al (2011), dehiscence in pediatric patients occurs in 8.6% of pediatric patients undergoing temporal bone CTs (one wonders why they were having temporal bone CT's). In this population, it was concluded that they were "unable to unable to identify any relationship between JBVAD and hearing loss". Of course, this leaves entirely open the question of whether jugular bulb dehiscence contributes to hearing loss in older persons as well as dizziness and tinnitus.

If tinnitus goes away with compression of the Jugular vein in the neck, it is usually not going to help to get any kind of radiology procedure. On the other hand, if somebody else can hear tinnitus (with a stethoscope on the skull), that is a good reason to get a vascular procedure.

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

Many highly professional and medical journal articles discuss cause and reason for artery and vein PT and somatic tinnitus that includes Atlantoaxial - C1, SCM muscle and thyroid. If you would like to read more let me know. I had recently posted some articles on what causes a hum and thumping.

 

@Greg Sacramento

Ahh, that sort of makes sense. So my pushing is somehow diminishing the blood flow through the jugular bulb, perhaps, helping to quite the pulsing nature of the tinnitus (if not the tinnitus itself)?

 

Yes, hyperextension of neck and twisting neck under a hypertension moment is a major cause of PT per neck causing vein and artery compression. More so while already having tinnitus and somatic in nature.

 

@Greg Sacramento

Well, this is going to be the weirdest thing I’ve ever typed, but yes, I’d like to read a bit more about the hum and thumping if you don’t mind.

 

https://www.centrallakesclinic.biz/cardiology/the-venous-hum.html
https://www.dizziness-and-balance.com/disorders/central/cervical/cervical.html

In this article about 3/4 down look for - How the internal jugular vein becomes compressed -
https://trainingandrehabilitation.com/association-tinnitus-neck-tmj/

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

 

@Greg Sacramento Thanks. Some of that seems familiar. I have a stiff neck quite often, sometimes so bad I can’t look straight up without significant pain. Also lots of shoulder pain, and I’m hypothyroid to boot!

 

@Greg Sacramento Sorry to bug you again. You seem to have done a ton of research on the subject. From what I understand from the doc, this high-pitched buzzing which I hear 24/7 that's synchronous with my heartbeat is a combination of somatic T being produced due to hearing loss in the high frequency range, which is then interacting with my heartbeat through either the jugular or carotid. He said I had such good hearing in the lower frequencies, that's why I'm picking up that venous hum or carotid noise, and it's interacting with that high pitched T. And if I squeeze my head at the back or side between my two palms , that's slowing down that venous outflow and eliminating the pulsating part of the PT, and really quieting the T portion.

My question is, I sort of get why it would slow or eliminate the P portion, but not the T part (if it is indeed from the high frequency hearing loss).

What really sucks for me is that I hadn't even thought too much about my PT for a couple of years now, since my doctors appointment back in Oct. 2017. It was just my unwelcome friend that I had to put up with when it came to my attention, so I was mostly habituated. Now it's back in the forefront because of some random push on my head. I don't think anything's changed since Oct. 2017, I have no idea why I'm obsessing!