Why Does Pulsatile Tinnitus Come and Go
February 27, 2021

Individual with Pulsatile Tinnitus


Sufferers of pulsatile tinnitus experience a rhythmic whooshing, throbbing, or whooshing in one or two ears. For some patients, the sounds are just annoying. But for others, it is debilitating and intense making it hard to sleep or concentrate.

Pulsatile tinnitus is different from the constant, common type of tinnitus. Though pulsatile tinnitus is most times benign, it often has an identifiable source and could be the first indication of a worse underlying condition.

But pulsatile tinnitus usually comes and goes occasionally, which can be quite deceptive to patients. However, since it is more often than not caused by an underlying condition, sufferers of pulsatile tinnitus should undergo a medical evaluation to find the reason for the sounds, which will explain why it goes and comes.

So first we'll go through the symptoms and causes to help you see why your tinnitus is there in the first place.

Pulsatile Tinnitus Symptoms

The most regular pulsatile tinnitus symptom is consistently hearing a whooshing or steady beat sound. The sounds or beats most times are in sync with your heartbeat. When your heart rate rises the sound of the beat will increase; when it drops the sound of the beat will decrease.

Though it is normal for humans to hear your heartbeat if your heart is pounding hard as a sufferer of pulsatile tinnitus you will hear it even if you have not exhausted yourself. The symptoms of pulsatile tinnitus may be more obvious at night as you lay in bed because there are fewer environmental sounds to mask the sounds or beat.

And as we've already seen, the sound or beat may go and come or be constant. Regardless of its frequency, its presence is due to the following underlying causes.

Pulsatile Tinnitus Causes

Pulsatile Tinnitus Causes


In most situations, your medical practitioner will be able to diagnose the underlying health problem causing your pulsatile tinnitus and this will help you understand why it comes and goes.

So let's look at a few of them:


People with atherosclerosis have plaque built-up within their arteries. And when the plague hardens it limits the flow of blood to the patient's head, neck, ear, and body as it narrows the arteries. This results in the sufferer hearing the rhythmic motion or thumping sound associated with pulsatile tinnitus in one or two ears.

Blood Vessel Malformations and Disorders

Pulsatile tinnitus can be caused by malformations or disorders in your arteries or blood vessels, especially those close to your ears. These disorders or abnormalities - including arteriovenous malformations and aneurysms can result in a change of blood flow in the affected blood vessel.

Abnormalities of the Ear

One of the three canals within the vestibular apparatus of your inner ear is the superior semicircular canal. People suffering from superior semicircular canal dehiscence syndrome, which is a condition that has part of the temporal bone overlying the superior semicircular canal missing or abnormally thin, experience pulsatile tinnitus.

A missing or thinning bone that overlies the main veins or arteries running close to the ear may also cause a person to hear their heartbeat.

High Blood Pressure

If your blood pressure is high your blood flow via the carotid artery will most likely be turbulent and this will cause a pulsating sound.

Neck and Head Tumors

Glomus tumors are both benign and locally invasive and stem from the glomus cells. They are commonly found in the jugular vein, which is just under the middle ear. However, these tumors can grow into the brain and middle ear.

If these tumors press on your neck, head or blood vessels, they will cause pulsatile tinnitus. Glomus tumors can also result in pulsatile tinnitus just by being near the ear.

Idiopathic Intracranial Hypertension

This health condition is a result of elevated cerebrospinal fluid pressure on your brain. This increased pressure results in symptoms like double vision, pain behind your eye, headaches and pulsatile tinnitus.

Sinus Wall Abnormalities

These sinus wall abnormalities include dehiscence, diverticulum, and sigmoid sinus. The sigmoid sinus is the blood carrying channel close to the brain that receives blood from veins inside the brain.

So sigmoid sinus diverticulum is the formation of tiny pouches (diverticular) that stick out through the sigmoid sinus walls into the mastoid bone behind the sufferer's ear. On the other hand, dehiscence is the absence of a part of the bone surrounding the sigmoid sinus in the mastoid.

Such abnormalities result in noise, pressure, and blood flow changes in the sigmoid sinus causing pulsatile tinnitus.

Additional Pulsatile Tinnitus Causes

The below conditions can also result in the characteristic whooshing or thumping sound of pulsatile tinnitus.

  • Head trauma
  • Paget's disease
  • Anemia
  • Hyperthyroidism - Overactive thyroid gland
  • Conductive hearing loss
  • Narrow blood flow tract from the brain

Diagnosing Pulsatile Tinnitus

Diagnosing Pulsatile Tinnitus


If you think that you have pulsatile tinnitus you need to have a thorough medical evaluation done by an otolaryngologist as they will be familiar with the situation. For some patients, the cause of their pulsatile tinnitus could be unknown but all serious possible causes must be ruled out.

The physician will have to ask about your medical history and then carry out a thorough exam of your cardiovascular system, neck, and head. The medical practitioner may also check your eyes for signs of increased brain pressure.

There are also imaging procedures that can be used to diagnose pulsatile tinnitus.

  • Magnetic resonance angiography (MRA)
  • Computerized tomographic angiography (CTA)
  • Ultrasound
  • Angiography
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • A thyroid function test and blood test can also be required to rule out thyroid or anemia problems.
  • Temporal bone CT scan

Why Your Tinnitus Comes and Go

Living with pulsatile tinnitus isn't easy, and if you're a sufferer you know that the sounds coming and going (spikes) can drive you nuts. So why does this happen? Besides the causes that keep it there in the first place, knowing the triggers of your pulsatile tinnitus is the first way to understand and prevent these spikes.

If you've had pulsatile tinnitus for some time you've likely noticed that the noise isn't always constant. It fluctuates - widely at that, and not just the sound but volume, frequency of sound, and intensity. Flare-ups such as these are called tinnitus spikes.

Out of the blue, the whooshing or thumping sound that seemed to disappear may come back much louder than before. You may even hear worse new sounds that weren't present previously, noises hard to ignore. Even if you've found out how to live with your pulsatile tinnitus, these spikes can still affect the quality of your life.

Fortunately, with a tad bit of effort, you should be able to find out what is the cause of your pulsatile tinnitus going and coming and get rid of it to live a better life.

Causes of Pulsatile Tinnitus Spikes?

Though pulsatile tinnitus spikes may appear to occur randomly, most times, they are caused by external factors in your surroundings, by your lifestyle or problematic areas of your health.

The issue though is that every cause of pulsatile tinnitus is unique and what causes yours to disappear or appear may not affect another person at all, and what negatively affects another could likely help your tinnitus get better. That said, there are a few frequently reported triggers for pulsatile tinnitus despite the variances.

Anecdotally, most patients who experience pulsatile tinnitus that comes and goes find that certain drugs, supplements, activities, environmental factors, and foods can cause spikes in the pulsatile tinnitus sounds.

Here are a few common triggers for pulsatile tinnitus:

  • Sleep deprivation
  • Stress or anxiety
  • Dehydration
  • Caffeine
  • High sodium diet
  • Recreational drugs
  • Certain medications

Unfortunately, this is just a small selection of the possible triggers of pulsatile tinnitus of a larger list that differs from patient to patient. However, finding out the cause of the trigger is just the first part of the battle.

The major problem here is that there are so many variables, which makes it tough to track everything accurately in your head. For instance, if your pulsatile tinnitus starts again in the afternoon after disappearing last night because of what you had for breakfast you probably will not spot the connection right away.

Such kinds of missed connections occur all the time and a lot of people aren't great at identifying these types of patterns.

However, with the correct approach, you can get rid of these natural limitations by spotting the connection easily. All you need to do is keep written records. If you have the right information before you, you'll be amazed at how great you are at identifying patterns. And the moment you can spot your pulsatile tinnitus triggers, you can make moves to avoid them.

This will not just assist you in reducing tinnitus spikes but will give you the details required to ensure you make better health decisions and accurately give your doctor proper feedback.

How to Track the Causes of Fluctuating Tinnitus

The last step in understanding why your tinnitus comes and goes and preventing such fluctuations is knowing what you're to track.

There are so many moving parts that you can easily get overwhelmed with the information you discover. So to succeed in the process you have to put your focus on identifying data points that will aid you in spotting your triggers.

Granted, you will have to track your pulsatile tinnitus throughout the day, penning how much it's distracting and the volume of the noise. But you need to track the various aspects of your lifestyle like anxiety and stress levels, sleep patterns, medications, supplements and vitamins taken alongside other aspects that you suspect are the case of your tinnitus spikes.

You’ll need to keep track of your tinnitus throughout the day, making note of how much it’s bothering you, and how loud it seems.

It's a lot to track but it's an extremely effective practice because with accurate information before you, organized in a clear way that allows you to identify patterns you can easily spot your triggers and get relief.

You just need to write out your observations every day and after doing this for one or two weeks you can check back and look for the days your tinnitus came back louder and look for similarities. This makes it so much easier to discover why your pulsatile tinnitus comes and goes.

You can also look for comparisons on the days that your tinnitus appeared negligible to spot your wellness triggers; the particular factors helping you to get better.

It's important to state though that through the process you may discover that your pulsatile tinnitus is caused by forces beyond your control (that is, there's nothing you can do to ease the underlying cause), or worse you may not discover anything at all in the process. Regardless of the outcome, don't give up.

The exercise aims to identify general trends and correlations, so it's very possible that you simply require more data to identify a clear pattern. Even if you discover the triggers are something you can't control then focus on the ones you can control like getting more sleep or rest if the cause of your pulsatile tinnitus is high blood pressure.

Identifying and steering clear of your pulsatile tinnitus triggers can tremendously help to stop the coming and going symptom associated with this kind of tinnitus. However, the most important thing is that the process gives you a sense of control and an approach to gain your power back.

By fully understanding your pulsatile tinnitus and the limitations involved, you'll be able to make informed decisions throughout your day as well as boost your quality of life, which is what matters the most.


Pulsatile tinnitus is one of the most unique types of tinnitus as it isn't just obvious to the patient but also to others like doctors who listen for the sounds. It also isn't majorly a result of loud sounds like other kinds of tinnitus but primarily caused by cardiovascular problems such as high blood pressure.

So the easiest way to handle it is by identifying the cause and curing it but in the process of treating this tinnitus type it comes and goes. Some days it is extremely loud and in others, it doesn't even appear like it's there. So how do you get closure as to why it comes and goes? Find a pattern, as there are usually triggers to amplifying your tinnitus sounds.

If you have additional comments about pulsatile tinnitus feel free to leave us a comment below.

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Drew Sutton M.D.

Drew Sutton, MD is a board-certified otolaryngologist. He has extensive experience and training in sinus and respiratory diseases, ear and skull base surgery, and pulmonary disorders. He has served as a Clinical Instructor at Grady Hospital Emory University for more than 12 years.

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