What Causes Pulsatile Tinnitus?

Some cases of pulsatile tinnitus are caused by a narrowing of one of the large veins in the brain (red circles). The narrowing, or stenosis, disrupts the flow of blood and can lead to the whooshing sound or other noises of pulsatile tinnitus.

Pulsatile tinnitus can be caused by problems in the arteries or veins of the head, neck, or both. A 2013 review of the current literature indicated that about 28 percent of pulsatile tinnitus cases were due to venous causes, 23 percent were arterial, 18 percent were arteriovenous, and 31 percent were due to other or unknown causes. More than half of the venous cases of pulsatile tinnitus were due to idiopathic intracranial hypertension (also called pseudotumor cerebri), which has recently been associated with venous stenosis.

Many cases of pulsatile tinnitus can be traced to stenosis in one of the large veins in the brain, most commonly the traverse and sigmoid sinuses. The narrowing of the veins causes a disturbance in the blood flow, contributing to the whooshing sounds of pulsatile tinnitus. A new clinical trial for pulsatile tinnitus shows great promise that inserting a stent to widen the veins will restore healthy blood flow and eliminate the symptoms.

Other conditions that can lead to changes in blood flow and result in pulsatile tinnitus include:

• Vascular malformations (including AVM and dural arteriovenous fistula): Pulsatile tinnitus is the result of abnormal connections between arteries and veins.
• Idiopathic intracranial hypertension (pseudotumor cerebri): This is a condition that consists of high pressure in the fluid around the brain and is characterized by headaches, dizziness, hearing loss, and visual disturbances.
• Venous sinus diverticulum: A small abnormal pouch on the wall of the vein transmits sound to the ear.
• Atherosclerosis (hardening of the arteries): When major blood vessels close to the middle and inner ear lose some of their elasticity, blood flow becomes more forceful and easier to hear.
• Head and neck tumors: A vascular neoplasm that presses on blood vessels in the head or neck can cause tinnitus and other symptoms.
• High blood pressure: Hypertension and factors that increase blood pressure, such as stress, alcohol, and caffeine, can make tinnitus more noticeable.

It is critically important to identify the underlying condition causing the pulsatile tinnitus; treating and resolving that condition is the key to ending the noise.

On the following pages, you’ll discover more about the symptoms of pulsatile tinnitus, how pulsatile tinnitus is diagnosed and treated, and a promising new clinical trial to relieve it.

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