Pulsatile tinnitus

Pulsatile tinnitus is a specific type of tinnitus and refers to the perception of rhythmic noise, usually in time with the patient's heartbeat, in the absence of an external source, which is most commonly but not exclusively due to underlying vascular pathology.

Patients describe pulsing noise that sounds like rushing, flowing, or humming. Some recognize synchronization with their pulse and an increase in the sensation with physical activity or in a recumbent position 10.

  • subjective pulsatile tinnatus: heard only by the patient
  • objective pulastile tinnatus: heard by clinician on auscultation (neck or mastoid region) 10 

Pulsatile tinnitus of venous origin may be associated with a low-pitched hum on auscultation and suppression of symptoms with manual pressure on the ipsilateral internal jugular vein.

On otoscopy, neoplasms and vascular anomalies protruding into the middle ear cavity may be seen as a retrotympanic vascular mass.

Numerous causes of pulsatile tinnitus are recognized, including 4,7-10:

CT, MRI and digital subtraction angiography (DSA) are all useful, depending on the underlying cause. They provide complementary information in the evaluation of pulsatile tinnitus. 

Given the wide range of entities that may present with pulsatile tinnitus, it is beyond the scope of this article to discuss each in turn. Rather, please refer to the articles for the specific entities above for individual imaging findings.

Article information

rID: 9789
Section: Gamuts
Synonyms or Alternate Spellings:
  • Differential diagnosis of pulsatile tinnitus

ADVERTISEMENT: Supporters see fewers/no ads

Cases and figures

  • Case 1: sigmoid sinus diverticulum
    Drag here to reorder.
  • Case 2: aberrant right internal carotid artery
    Drag here to reorder.
  • Case 3: dural arteriovenous fistula
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.