Highlights
- Pulsatile tinnitus is a condition in which you hear a rhythmic noise, usually in time with your heartbeat, in one or both ears.
- High blood pressure, hearing loss, blood vessel abnormalities, and ear infections are just a few medical conditions that can cause pulsatile tinnitus.
- Anxiety is not a common cause of pulsatile tinnitus, but they may co-occur.
- Treatment of pulsatile tinnitus depends on its underlying cause.
Have you ever heard the sound of your heartbeat echoing in your ears, particularly in stressful or anxious circumstances?
In this article, we explore the link between pulsatile tinnitus and anxiety, when to seek professional help, and offer specific tips to help you cope with this uncomfortable condition. Whether you’ve had pulsatile tinnitus for ages or it’s just started, this guide will help you understand and deal with the condition.
What Is Pulsatile Tinnitus
Let’s break it down:
- Tinnitus is a sound you hear
coming from inside the body[1] rather than your surroundings; typical tinnitus is often described as a constant ringing. - Pulsate means to beat rhythmically.
- Pulsatile tinnitus is an internal sound that follows a rhythm, usually in time with your pulse, in one or both ears.
Essentially, it feels like your heart is beating in your ear, but the quality can vary. Here are some common descriptions:
- Swooshing noises
- Whooshing sounds
- Drum-like thumping sounds
- Pounding heartbeat sounds
- Low-pitched sounds, like someone walking in the snow
- High-pitched noises, like birds screeching
When to Get Medical Help
There are some red flags or warning signs indicating a possible serious medical condition to watch out for.
The ‘ER now’ symptoms and situations are:
- Severe headaches
- Sudden hearing loss
- Numbness
- Weakness
- Vision changes
- A recent head injury, even if you didn’t think it was serious
The ‘see a doctor ASAP’ symptoms include:
- New onset of pulsatile tinnitus in one ear
- Pulsatile tinnitus that doesn’t settle or is getting worse
Now, here are the possible reasons why you have pulsating sounds in one or both ears.
Causes of Pulsatile Tinnitus
The
Let’s chat about the blood vessels first: anything that affects blood flow can create noise. Think of a blood vessel as a garden hose.
- If you open the tap more but keep the nozzle size the same, the increased water pressure makes more noise. The same is true for increased blood flow in the blood vessels.
- If you fold the hose, it will cause noise at the kink due to turbulence. Abnormal blood vessels, if they become narrow or wide, or bend unusually, do the same because of blood flow changes.
The most common cause of pulsatile tinnitus is very
Other vascular causes include:
- Cholesterol deposits in arteries
- Tumors
- Aneurysms
- Thickened blood vessel walls
- Arteriovenous malformations: abnormal connections between arteries and veins
Hearing less outside noise makes internal sounds seem louder:
- Middle ear hearing loss from noise exposure or aging
- Blocked ear canals, e.g., with wax
- Middle ear infections
Conditions that cause the heart to pump harder and faster:
- Overactive thyroid gland
- Pregnancy
- Anemia
- Anxiety
The Relationship Between Pulsatile Tinnitus and Anxiety
Anxiety can cause or worsen pulsatile tinnitus for three reasons. People with anxiety disorders or other mental health conditions often experience:
- An easily triggered stress or
fight-or-flight response[3] . This temporarily results in a faster, more forceful heartbeat and increases blood pressure. Muscle tension[4] , especially in the jaw and neck, which can cause pulsatile tinnitus, most likely due to changes in blood flow.- A heightened awareness or concern about one’s health might lead them to
focus more on bodily symptoms[5] , such as tinnitus or pain.
This can result in people with anxiety hearing a heartbeat or whooshing in their ears during stressful situations, or even just by focusing intensely on themselves.
Worse still, this can start an anxiety-tinnitus loop: the anxiety causes tinnitus, which causes more anxiety.
Long-standing stress and anxiety, if left untreated, may
Diagnosis: How Pulsatile Tinnitus Is Evaluated
Pulsatile tinnitus from stress or anxiety is a diagnosis of exclusion. In other words, your healthcare provider needs to check for other underlying conditions first. So, let’s chat through the steps you should follow and what might happen.
Who to see first:
- Start with your family physician.
What they’ll do:
- Your healthcare provider will perform a thorough physical examination, including checking your blood pressure and heart rate, examining your ears, listening to your neck blood vessels, and asking about other symptoms you’re experiencing.
- They might request blood tests to exclude conditions such as thyroid problems and anemia.
- If they find nothing significant, they will refer you to other healthcare providers.
Onward referrals:
- Audiologist for a hearing test.
- ENT specialist for a thorough head-and-neck examination.
When to do imaging:
- These are rarely needed and usually only when blood vessel abnormalities or tumors are suspected.
Anxiety-related pulsatile tinnitus is only diagnosed when no other physical root cause is found, and there are convincing anxiety symptoms.
How to Stop Pulsing in the Ear Due to Anxiety?
Here are some ‘in the moment’ and baseline coping strategies you can try that might relieve symptoms of anxiety-related pulsatile tinnitus.
What to Do During a Spike
Try this 3-step plan.
Step 1: Do breathing exercises
Deep breathing exercises are proven to slow down the fight-or-flight response; box breathing is an easy-to-remember technique you can try:
- Breathe in for 4 seconds
- Hold for 4 seconds
- Breathe out for 4 seconds
- Hold for 4 seconds
Repeat this for four cycles.
Step 2: Listen to neutral sounds
Find a neutral, low-pitched, constant sound in your environment to focus on; it should draw your attention away from internal tinnitus without distracting you from your daily activities. Examples include:
- A fan or air conditioner hum
- A white noise machine
- Listening to ocean or rain sounds with a headset
Step 3: Stop checking
Set a timer, say for an hour, and commit to stopping yourself from checking for the pulsatile tinnitus noise.
Daily Routine Tips
- Diet and Lifestyle Changes: Reducing salt helps control blood pressure, which may lessen pounding in the ears. Limit or avoid nicotine and coffee, as they might aggravate tinnitus.
- Nighttime Plan: To actively stop pulsing in the ear at night, try sound generators such as white noise machines. They can help to draw focus away from internal sounds. Also, getting a good night’s sleep improves anxiety. Ensure your bedroom is cool and dark, avoid screens before bedtime, and practice a relaxing wind-down, like listening to music or taking a warm bath or shower.
- Stress Management:
Yoga and mindfulness meditation[7] can reduce anxiety.
Treatment for Pulsatile Tinnitus
The approach to treating pulsatile tinnitus will depend on the underlying medical causes, and treatment options could include:
- Blood pressure medication
- Cholesterol medication
- Iron or vitamin supplements or infusions for anemia
- Thyroid medication
- Antibiotics for ear infections
- Removal of earwax
- Hearing aids
- Trial of medication changes
- Surgery might be necessary for blood vessel problems
As you now know, there are many conditions to exclude before confirming the pulsatile tinnitus is linked to anxiety, so avoid the temptation to self-diagnose or stop any medication suddenly.
For anxiety-related pulsatile tinnitus, treatment may include behavioral therapy that helps reduce the cycle of worry and hyperfocus.
- Retraining Therapy for Tinnitus (TRT):
TRT[8] combines patient education about why they have tinnitus with sound therapy that masks their tinnitus with an external source. Over time, a deeper understanding of the condition and training the brain not to focus on internal sounds might reduce distress from the symptoms. - Cognitive-behavioral Therapy (CBT): This can specifically help to
change or challenge the negative anxiety-induced thoughts about tinnitus[9] , but is also aproven therapy[10] for anxiety and stress-related disorders.
Summing Up
Pulsatile tinnitus, although it is sometimes associated with anxiety, can be a symptom of a serious medical condition. So, don’t self-diagnose; always consult a healthcare provider before assuming it is stress-related.
However, if you’d like to find out more about anxiety, our licensed medical team at MEDvidi is available online, so book your appointment today and get all your questions about anxiety treatment answered.
Frequently Asked Questions
What is the most common cause of pulsatile tinnitus?
Can emotional stress cause pulsatile tinnitus?
Emotional stress can cause pulsatile tinnitus because the fight-or-flight response changes blood flow by making the heart pump harder and faster and raising blood pressure.
Is tinnitus linked to mental health?
Can tinnitus be psychosomatic?
Why is pulsatile tinnitus a red flag?
Pulsatile tinnitus might be a red flag, or warning sign, because it may be caused by an underlying blood vessel problem requiring urgent medical attention.
Can I live a long life with tinnitus?
You can live a long life with tinnitus as long as you have addressed the underlying cause.
