If you've ever been to a concert or sat too close to a loud speaker, you've likely experienced the resultant ringing in your ears afterward.
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But if you frequently hear a sound that's in sync with your heartbeat or a pounding pulse in your ear, you might be dealing with pulsatile tinnitus, a condition characterized by rhythmic thumping, whooshing or throbbing in one or both ears, according to Penn Medicine.
Don't panic. Pulsatile tinnitus is often temporary and harmless, says Oliver Adunka, MD, the director of the division of otology/neurotology and cranial base surgery at OSU Wexner Medical Center.
Still, there's usually a recognizable reason for the condition, as it may be the first sign of an underlying (sometimes serious) health issue, Dr. Adunka says. To be safe, you should always seek medical attention and a proper evaluation if you experience a persistent pulse in your ear.
Here, Dr. Adunka runs through the causes of pulsatile tinnitus.
1. A Strenuous Workout
Anyone who's ever pushed through a strenuous sweat session has probably heard their heart pump in their ears post-workout. This is very normal, Dr. Adunka says.
When you exercise vigorously, your cardiac output increases, briefly boosting how much blood is flowing through your vessels, including those near your ears, he explains. And this temporary rise in blood flow can sometimes produce a pounding sound in your ears.
With anemia, the blood composition changes — your red blood cell count is low — which can trigger turbulent blood flow in the veins, Dr. Adunka says. And this turbulent flow can generate the thumping noise in your ears.
Here's why: Behind the ears, there are big blood vessels that transport blood from the brain back to the heart. Usually, you can't hear those vessels, but if the blood flow through them is forceful (like in the case of people with anemia), you can, Dr. Adunka says.
He uses the analogy of a river to illustrate the point: If the water is running smoothly, it's mostly silent. However, if you have white water, it's very loud. Due to the altered blood composition, people with anemia essentially have "white water" coursing through their veins.
3. Thyroid Issues
Similarly, thyroid conditions can alter the composition of the blood, Dr. Adunka says. And this can sometimes cause fluctuations with blood pressure that can affect the venous return to the heart and produce pulsations in your ears, he explains.
4. Fluid in the Ear or an Ear Infection
Folks who have fluid in the middle ear, which may or may not be related to an ear infection, often hear their heartbeat. That's because the blood vessels around the ear will usually pulsate the fluid (which temporarily replaces air) in the middle ear, Dr. Adunka says.
5. High Blood Pressure
If you have high blood pressure, it can cause the blood to flow through your veins and arteries with more force, according to Harvard Health Publishing. (Your blood pressure is high when the top number is 120 or higher and/or the bottom number is over 80, for the record.)
And when there's turbulent blood flow through the carotid artery, this can produce a pulsating noise in your ears.
In atherosclerosis, a plaque of fats, cholesterol and other substances builds up inside the arteries, which can become narrowed.
When this happens, it blocks blood flow to the body, including in your ears, neck or head, causing you to hear the rhythmic thumping in your ears, per Penn Medicine.
From morning sickness to hemorrhoids, pregnancy produces a plethora of pesky side effects, and now you can add pulsatile tinnitus to the inventory of irritating symptoms.
During pregnancy, you experience an increase in circulating blood volume and blood pressure, which, as we know, can affect the major blood vessels surrounding the inner ear, according to the British Tinnitus Association (BTA)
What's more, when you're expecting, you naturally retain more salt and water (hello, swollen feet and ankles) that can cause localized inflammation and impact the tissues near the ear, per the BTA.
And that's not all: Hormonal fluctuations can change the nerve cell activity of the inner ear, triggering or increasing pulsatile tinnitus, according to the BTA.
Luckily, the pounding in your ears usually resolves or reduces after you give birth.
Why Can You Hear Your Heartbeat in Your Ear When Lying Down?
This has to do with the sigmoid sinus, a large blood vessel behind your ear that leaves the brain and drains into the jugular vein, Dr. Adunka says.
“If you turn your head or hold it in a certain way, you basically change the position of the sigmoid sinus and how much blood is going through that vessel behind your ear,” he says.
For instance, when you push into your neck (right next to your larynx), you can make the vessel smaller. For some people, this can decrease (or increase) the thumping in their ears, Dr. Adunka says.
Likewise, when you lie down, especially on your side, you can affect the position of the sigmoid sinus, and this can result in a louder pounding noise.
Plus, you’re more likely to hear your heartbeat in your ears at bedtime because it’s quiet and there are fewer distractions, Dr. Adunka adds.
Less Common Causes of a Pulse in Your Ears
While rare, sometimes the source of pulsatile tinnitus can be a serious health issue that requires immediate medical intervention like the following:
8. Idiopathic Intercranial Hypertension
Idiopathic intercranial hypertension (IIH) — a condition characterized by high pressure in the brain — can cause a hammering heartbeat noise in your ears as well, Dr. Adunka says.
Other symptoms of IIH include the following, per Cedars Sinai:
- Blurry (or double) vision
- Vision loss
- Neck stiffness
- Difficulty walking
- Frequent headaches
Paragangliomas — rare, neuroendocrine tumors in the head and neck that are typically benign — almost always present with pulsatile tinnitus, Dr. Adunka says.
Depending on the tumor's location, paragangliomas can also cause symptoms such as the following, according to the Stanford Ear Institute:
- Facial, tongue and shoulder weakness
- Difficulty swallowing
- A drooping eyelid
- High blood pressure, elevated heart rate or intermittent sweating and anxiety (in very rare cases)
10. Arteriovenous Malformation
An arteriovenous malformation (AVM) — an anomaly of blood vessels — can also be the basis of the beating in your ears, Dr. Adunka says.
With an AVM, arteries and veins become intertwined and tangled (the high-pressure system in the arteries gain access to the low-pressure system in the veins), Dr. Adunka explains. And it's this abnormal connection between blood vessels that causes the noise.
Other AVM symptoms include, per Johns Hopkins Medicine:
- Loss of sensation in part of the body
- Muscle weakness
- Changes in vision
- Facial paralysis
- Drooping eyelids
- Problems speaking
- Changes in sense of smell
- Problems with motion
- Loss of consciousness
- Cold or blue fingers or toes
If undetected, an AVM can lead to serious complications, such as spontaneous brain bleeds, Dr. Adunka says.
When to See a Doctor for Pulsatile Tinnitus
An incessant thumping in your ears is incredibly irritating and can interfere with your daily life, making it difficult to concentrate or sleep. "People shouldn't have to live with it," Dr. Adunka says.
While most cases of pulsatile tinnitus are temporary, you should seek medical help if the pounding in your ear persists, especially because it can be a sign of a more serious underlying health issue.
Dr. Adunka recommends seeing a neurotologist — a highly specialized ear, nose and throat doctor — who has more experience than a general practitioner or family physician when it comes to inner ear concerns.
Once you receive a proper medical evaluation and diagnosis, you can treat the problem at the source and put a stop to the pulsing in your ears.
Is This an Emergency?
- Penn Medicine: "Pulsatile tinnitus"
- Harvard Health Publishing: “Ask the doctor: Is it worrisome to hear a pulse in my ear?”
- British Tinnitus Association: “Tinnitus and pregnancy”
- Cedars Sinai: “Idiopathic intercranial hypertension”
- Stanford Ear Institute: “Paragangliomas / Glomus Tumors of the Head and Neck”
- Johns Hopkins Medicine: “Arteriovenous Malformations”