What is pulsatile tinnitus ?
Throbbing or throbbing heard in one or both ears is called tinnitus or pulsatile tinnitus . It is an uncommon otological symptom that affects 5% – 10% of patients who come with tinnitus, that is, with noises in the ears. It is more common in females and most (85%) are only heard in one of the two ears, but bilateral presentation can occur.
Sometimes it occurs only at bedtime and is usually synchronous with the heartbeat. But there are various manifestations, so we must go to the doctor for a physical examination and look for the cause.
Why is my ear throbbing and throbbing?
Tinnitus in general, without being associated with this heartbeat, can manifest itself with noises, clicks, beeps, buzzing or whistling . These sounds are perceived when there is no external sound that causes such perception. About 15% to 20% of the general population will experience tinnitus at some point in their lives, and this number increases with age
Tinnitus is a symptom, not a disease , and it can appear because something is wrong with our hearing system. The auditory system is not only made up of the eardrum and the bones that we studied as children: anvil, stirrup, hammer. It also encompasses the auditory nerve and the brain areas that help process sound.
Sometimes tinnitus appears without any apparent cause . Others, it is related to a plug of wax, with stress, with cervical contractures. And others can be a symptom of more serious disorders or diseases , as described by the National Institute on Deafness and Other Communication Disorders of the United States (NIDCD, for its acronym in English):
- Noise-induced hearing loss.
- Ear and sinus infections.
- Diseases of the heart and blood vessels.
- Meniere’s disease .
- Brain tumors.
- Hormonal changes in women.
- Thyroid abnormalities.
Specifically, pulsatile tinnitus is usually the result of problems with blood flow in the head or neck due to stenosis in arteries , arterial or venous malformations near the ear, aneurysms, tumors, heart murmurs. It can also be due to benign intracranial hypertension , increased blood supply from otitis or middle ear problems (such as fluid buildup, wax plug), or Eustachian tube problems and trauma.
Galindo et al state that “ pulsatile tinnitus can also have a muscular origin , as a result of spasm of one or both muscles of the middle ear due to ear disease or neurological diseases such as multiple sclerosis ”. And on other occasions it has no apparent cause or any serious problem behind it.
What should I do if I have tinnitus ?
As explained, within the causes there are some serious and others less serious. There is no need to panic, this is applicable to a leg that hurts. It can be anything (tumor, vascular cause, muscular cause, bone or tendon cause, etc). Without being an emergency, it is best not to let time pass and apply the appropriate treatment. To do this, we must go to our family doctor , who will do a first physical examination and what he considers necessary. If he considers it, he will refer us to the otolaryngologist to continue with the exploration or the solution of our problem.
Although it must be taken into account that, in some cases, it is not possible to identify the origin of the problem and many tinnitus persist for years .
How can tinnitus be cured?
To date, there is no scientifically proven or documented cure for tinnitus . Even so, according to Wimmer et al., they refer that “currently there are new pathophysiological theories that try to understand tinnitus as a disease that involves structural and functional changes in the brain that have given rise to innovative treatment measures” .
Most people who live with tinnitus for which the cause and solution cannot be found, can learn to cope. Although in some cases it is so severe that people have trouble hearing, concentrating or even sleeping. And it has been associated with sleep disturbances, a higher prevalence of depression, irritability, anxiety, attention problems, and higher rates of suicide.
Wimmer refers in his study that tinnitus is a symptom secondary to multiple etiologies, of complex study and management . He states that ” in the case of non-pulsatile tinnitus, there may be a high neuropsychiatric comorbidity, including anxious and depressive symptoms with alterations in brain networks that involve cognition and emotion .”
Treatment of tinnitus
Until new treatments are developed based on these studies, the measures currently available to us are education and counseling, prescription hearing-enhancing devices, non-prescription devices that generate background sounds, psychological treatment, and relaxation therapy .
In extreme cases, cochlear implants may be indicated. Pharmacotherapies are used to treat complaints associated with tinnitus such as sleep difficulties, anxiety or depression. There are no drugs to treat tinnitus itself . So beware of the miraculous therapies that are sold and advertised on the Internet, taking advantage of the desperation of some people.
On the other hand, some basic actions are also recommended that can prevent the tinnitus from getting worse: avoid exposure to noise, loud music, avoid stress , practice some relaxation exercises, sleep enough hours. Many people find that their tinnitus is increased by drinking coffee, alcohol, or smoking. So you have to eliminate these habits.
References:
Galindo L. (2020). Etiology of pulsatile tinnitus. Clinical case. Journal of Otolaryngology and Head and Neck Surgery, 80(3), 329–333. DOI:10.4067/s0718-48162020000300329
National Institute on Deafness and Other Communication Disorders. (2017). Tinnitus. Recuperado el 29 de junio de 2022, de NIDCD website: https://www.nidcd.nih.gov/es/espanol/tinnitus
Ricci L et al. (2018). Pulsatile tinnitus: Clinical case and review of the literature. Journal of Otolaryngology and Head and Neck Surgery, 78(3), 300–304. DOI:10.4067/s0717-75262018000300300
Wegner I, et al. (2018). Betahistine for tinnitus. Cochrane Database of Systematic Reviews, 12(12), CD013093. DOI:10.1002/14651858.CD013093.pub2
Wimmer et al. (2019). Tinnitus: A brain pathology. Journal of Otolaryngology and Head and Neck Surgery, 79(1), 125–136. DOI: 10.4067/s0718-48162019000100125
