Is Pulsatile Tinnitus Dangerous? When to See a Doctor

If you’ve ever experienced a persistent ringing, buzzing, whistling, or hissing sound in your ears when no external noise is present, you’re not alone. This condition, called tinnitus, affects more than 50 million American adults, and I see patients struggling with its impact on their daily lives every day in our practice at New Jersey Brain and Spine.

While most people are familiar with traditional tinnitus as “ringing in the ears,” there’s a less common but particularly concerning variant that I want you to know about.

pulsatile tinnitus: About 4 percent of tinnitus sufferers experience this rhythmic whooshing sound that pulses in sync with their heartbeat. As an endovascular neurosurgeon, I’ve seen how pulsatile tinnitus can be a warning sign of underlying vascular issues in the neck or head. These conditions, while serious, are often very treatable when caught early. 

What Are the Causes of Pulsatile Tinnitus?

Common causes of pulsatile tinnitus include: 

• High blood pressure increases the force of blood against the arterial walls and can produce a noticeable sound in the ears. 
• Ear infections and inflammations. The accumulation of fluid in the middle ear can transmit vascular sounds. 
• Narrow arteries: Conditions including atherosclerosis — where arteries are clogged with cholesterol plaques — can disrupt normal blood flow. 
• Intracranial hypertension involves increased pressure of the fluid surrounding the brain, and can affect auditory perception.
• Arteriovenous malformation: In some cases, a malformation of the blood vessels (arteriovenous malformation)  of the head or neck may cause pulsatile tinnitus. 

Other causes include anemia, hyperthyroidism, and certain kinds of brain tumors.  

Is Pulsatile Tinnitus Dangerous?

Pulsatile tinnitus can be both an acute (temporary) condition or a chronic (ongoing) health condition. In both of these scenarios, myself and/or the team from New Jersey Brain and  Spine can help in providing high-quality care, clear communication, and support for the psychological needs that also accompany a physical diagnosis. 

Yes, pulsatile tinnitus can be dangerous — but most cases are benign. Many cases are also curable, depending on the underlying cause. 

You might be asking yourself, “Should I see a doctor immediately?” The red-flag symptoms that you should address immediately are those with a sudden onset, especially if you’re dizzy, your vision changes, or you have sudden hearing loss. Neurological symptoms like weakness, numbness, or difficulty speaking could indicate a more serious condition. 

How Is Pulsatile Tinnitus Diagnosed?

Effective treatment hinges on a proper diagnosis, and there are all kinds of tests to determine the cause and potential treatments.

In addition to a comprehensive review of medical history and a thorough physical exam that includes listening to the heart and lungs, we typically perform other types of procedures. These include hearing tests, and vascular imaging tests like MRI or CT scans that allow us to visualize blood vessels and check for abnormalities. We also use state-of-the-art angiography for a detailed perspective of patients’ blood vessels, including abnormalities in the arteries or veins. 

What Are Treatment And Management Methods for Pulsatile Tinnitus?

If high blood pressure is leading to a patient’s pulsatile tinnitus, antihypertensive medications can help. Other more straightforward treatment approaches include patients adopting lifestyle changes like reducing sodium intake, stress management, and regular exercise. All of these can improve your vascular health. 

Some patients—especially those with tumors, or arteriovenous malformations (AVM)—may require surgery. Stenting is also a minimally invasive course of treatment for narrow blood vessels that is performed minimally invasively. The procedure includes placing a soft mesh stent to open up a narrowed blood vessel and normalize blood flow. Patients  can usually return home within one to two days. 

Case Study: One Patient’s Journey with Pulsatile Tinnitus 

Tom, a 58-year-old school bus driver came to see me after experiencing eight months of constant whooshing sounds in his right ear that matched his heartbeat. He was exhausted, couldn’t concentrate during classes, and hadn’t slept well in months. After listening to his symptoms and examining him, I ordered a CT angiogram that revealed a dural arteriovenous fistula—an abnormal connection between blood vessels near his ear that was creating the turbulent flow he was hearing.

Using a minimally invasive endovascular procedure, I navigated a tiny catheter through his blood vessels and sealed off the abnormal connection with special coils. The procedure took about two hours, and when Tom woke up in recovery, the whooshing was gone. 

Tom’s story reminds me why I love what I do and why early evaluation of pulsatile tinnitus is so important. Many causes are completely curable, not just manageable, with modern techniques. If you’re experiencing these symptoms, please don’t wait—let’s work together to find your path back to silence.

[name and details have been changed to preserve patient anonymity]

Schedule an Appointment Today

Whether you need a diagnosis, a second opinion, or just someone to help you make sense of your symptoms, the team from New Jersey Brain and Spine is here. We take the time to listen, explain your options, and work together on the next steps. We would be honored to be part of your care team. Schedule an appointment.