The Medical Consumer's Advocate
Pulsatile (throbbing) tinnitus
Q:
I can hear my heart beat in
my right ear. My family doctor told me I have ETD and
gave me sudafed to take for 30 days. I got no results
from this treatment. When I do a valsalva the noise goes
away but as soon as I move my jaw the noise comes back. I
have no pain and I fly for a living and have no trouble
clearing on descent. Do I have ETD or does it sound like
something else? This has been going on now for several
months and I need to get this resolved so I can sleep
better at night.
A: This is referred to as pulsatile
tinnitus. Could be due to ETD (Eustachian tube dysfunction) but I doubt it. The bit about
the valsalva bugs me... I keep thinking that this is an
important clue but I can't quite get my brain around it.
I spoke to a friend of mine, who is
an otologist (ear specialist), and he had the same thought
that I had had -- a valsalva maneuver should, if anything,
tend to worsen the tinnitus. Neither one of us have any
bright ideas regarding this particular aspect of your
symptoms.
I want to give you an overview of
the different kinds of problems that can cause pulsatile
tinnitus (tinnitus which throbs at the same rate as your
heart beat ... I assume you have already determined whether
this is, in fact, the case, by feeling your pulse and
listening to the tinnitus at the same time).
Here's a partial list, hitting the
high points:
Vascular disorders (high blood
pressure; abnormal placement of vessels within the middle
ear; blood vessels which are abnormally narrow; aneurysms;
arteriovenous malformations).
Tumors in or near the ear that are
highly vascular.
Middle ear inflammation due to
acute or chronic infection, or Eustachian tube dysfunction.
Muscle spasm within the ear or
throat (myoclonus). The noise will be repetitive but will NOT coincide
with your heartbeat, if your problem is myoclonus.
The big worry, obviously, is that
the pulsatile tinnitus is related to a vascular disorder or
highly vascular tumor. If you see an ENT, he/she will know
how to examine you with this in mind and will know the
appropriate tests that need to be done to figure this out.