Pulsatile tinnitus: when a heartbeat sound in your ear needs a doctor

This page is general information, not medical advice. If you have stroke signs, call 911 now. See our medical disclaimer.

Pulsatile tinnitus is a rhythmic whooshing, thumping or swishing sound that keeps time with your heartbeat. It is much less common than ordinary ringing: fewer than 10% of people who see a doctor for tinnitus have the pulsing kind ^[3]. But it is more likely to have a specific, physical cause. With a proper work-up, a cause is found in about 70% of cases ^[3][4], and many of those causes are treatable ^[1].

That is why pulsatile tinnitus deserves a medical evaluation, not just a white-noise app. The AAO-HNS tinnitus guideline advises against routine scans for tinnitus but makes pulsatile tinnitus one of four exceptions where imaging is appropriate ^[2].

When to go now, and when to book a visit

Call 911 if the pulsing comes with any stroke sign ^[6]:

• Sudden numbness or weakness in the face, arm or leg, especially on one side
• Sudden confusion, trouble speaking or trouble understanding speech
• Sudden vision problems
• Sudden trouble walking, dizziness or loss of balance
• A sudden, severe headache with no known cause

Get seen the same day (ENT, urgent care or emergency department) if the pulsing starts with a new severe headache, changes in your vision, or new vertigo. A 2025 clinical review treats severe headache, vertigo or visual changes alongside pulsing as signs that call for imaging ^[5]. Also get same-day care if you suddenly lose hearing; read our sudden hearing loss guide.

Book an appointment soon with your primary care doctor or an ENT if you have new pulsing that won't go away and you otherwise feel well. When you call, use the word "pulsatile" so the office knows it isn't ordinary ringing.

Is it pulsatile? How to tell

	Typical tinnitus	Pulsatile tinnitus
Sound	Ringing, buzzing or whistling [3]	Whooshing or thumping that matches your heartbeat [3]
Which ear	Varies	Usually one ear [3]; both ears can point to whole-body causes such as anemia or an overactive thyroid [5]
Can a doctor hear it?	No	Sometimes, with a stethoscope. This is called objective tinnitus [1]
Likely cause found?	Often linked to hearing loss or noise exposure [1]	A cause is found in about 70% of cases [3]
Imaging	Not routine [2]	Usually part of the work-up [1][2]

A simple self-check: sit somewhere quiet, find your pulse at your wrist, and see whether the sound keeps the same beat. Before your visit, write down when it's loudest, whether turning your head or exercise changes it, and whether you've had headaches, vision changes, weight gain or a recent head injury. Leave neck-pressure tests to your clinician.

What causes pulsatile tinnitus

Most causes involve blood flow near the ear: changes in an artery or vein, an abnormal connection between the two, or a condition that makes blood flow faster or louder ^[3][5]. A 2025 review names narrowed arteries and idiopathic intracranial hypertension as the leading causes ^[5].

Cause	What it is	Clues clinicians look for
Hardened or narrowed arteries (atherosclerosis)	Plaque in neck arteries makes blood flow turbulent [5]	Older age, high blood pressure, diabetes, smoking; a whooshing "bruit" heard over the neck [5]
Idiopathic intracranial hypertension (IIH)	Raised pressure in the fluid around the brain; the most common vein-related cause [5]	Mostly women with overweight or recent weight gain; headaches and vision problems; sound often fades when the neck vein is gently pressed [5]
Vein and bone variations near the ear	Thin or missing bone over a large vein, or a jugular vein that sits higher than usual [5]	Low-pitched whoosh that changes with head turning [5]
Dural arteriovenous fistula	An abnormal artery-to-vein connection in the brain's covering; up to 20% of pulse-synchronous cases in some reports [5]	History of head injury; a bruit sometimes heard behind the ear; some can cause bleeding in the brain [5]
Paraganglioma (glomus tumor)	A vascular tumor near the ear; the most common skull-base vascular tumor behind pulsatile tinnitus [5]	A mass visible behind the eardrum [3]; sound often worse with physical activity [5]
High blood flow conditions	Anemia, overactive thyroid, pregnancy, heart valve disease [5]	Often both ears; blood tests can confirm [5]
Ear-bone conditions	Superior canal dehiscence, otosclerosis, Paget's disease [5]	Hearing test may show a conductive pattern [5]

What happens at your evaluation, step by step

1. History. Expect questions about when the sound started, which ear, what changes it, headaches, vision, weight changes, blood pressure, recent head or neck injury, and your medicines ^[5]. The guideline asks clinicians to start every tinnitus visit with a targeted history and exam ^[2].
2. Ear exam. Your clinician looks in your ear with a lighted scope, partly to spot a mass behind the eardrum ^[3].
3. Listening with a stethoscope. They may listen over your neck, around your ear and over your skull for a bruit ^[5].
4. Simple maneuvers. Gentle pressure on the neck vein, turning your head, or bearing down can change venous sounds. Vein-related tinnitus is typically low-pitched and often fades with these moves; artery-related tinnitus often doesn't ^[5].
5. Blood pressure and weight check ^[5].
6. Hearing test. An audiogram can reveal patterns such as otosclerosis ^[3]. Our guide to what happens at a hearing test explains each part.
7. Blood tests, especially if both ears are affected, such as a blood count and thyroid tests ^[5].
8. Eye exam and possibly a lumbar puncture if IIH is suspected. IIH often causes swelling at the back of the eye, and the diagnosis is confirmed by measuring fluid pressure ^[5].
9. Imaging, chosen based on everything above.

Which scans you might get, and why

No single scan finds everything. CT and MRI give complementary information, and your doctor will pick based on your exam ^[3].

Test	Best at showing	Share of scans that found a diagnosis [4]
CT angiography (CTA)	Blood vessels and bone together, such as vessel variants and gaps in the bone over vessels [3]	86%
CT of the temporal bone	Bone defects and middle-ear masses [3]	65%
MRI with MR angiography or venography	Higher-risk causes such as fistulas, artery disease, IIH and tumors, without radiation [5]	58%
Carotid ultrasound	Narrowing in the neck arteries [3]	21%
Catheter angiography (DSA)	The most detailed view of fistulas and malformations, often used to plan treatment [3][5]	Not reported

Read those percentages with care. The review pooled 17 studies and 1,232 patients, the studies varied a lot in who got scanned and why, and the authors note that yields improve when scans are ordered for specific clinical reasons ^[4].

Treatment depends on the cause

The 2025 review puts it simply: treating the underlying cause often makes pulsatile tinnitus go away ^[5]. Examples from that review ^[5]:

• Narrowed arteries: medical management or a procedure to restore blood flow often resolves the sound.
• IIH: weight reduction first, which reverses symptoms for many patients; then medicines that lower fluid pressure, such as acetazolamide. Some people need a shunt or venous sinus stenting.
• Dural arteriovenous fistula: a catheter procedure (embolization) or focused radiation to close it off, and sometimes surgery.
• Paraganglioma: surgery, embolization or radiation, depending on the stage of the tumor.
• Jugular bulb and sinus bone defects: catheter-based or surgical repair, weighing risks against benefits.
• Anemia or thyroid disease: treating the condition itself is the first step.

If no cause turns up, the tools used for ordinary tinnitus still help. See our guide to tinnitus treatments with real evidence.

Questions to ask your doctor

• Do you hear a bruit when you listen to my neck or behind my ear?
• Does my history point to an artery cause, a vein cause, or something else?
• Which scan are you ordering, and what is it looking for?
• Do I need an eye exam or blood tests?
• If the scans are normal, what's the plan for managing the sound?

If you need a starting point, find an ENT or audiologist near you and mention pulsatile tinnitus when you book.