Pulsatile Tinnitus And High Blood Pressure

If you have ever heard of sounds in your ear like ringing or buzzing without any external causes, then you may have tinnitus. According to the National Institute for Health and Care Excellence (NICE), about 7.1 million people, which is approximately 13% of adults in the UK, experience prolonged tinnitus. Tinnitus is not a medical condition, but rather a symptom of a condition that needs to be investigated.

Pulsatile tinnitus is a type of tinnitus often described as a throbbing sound at the same pace as your heartbeat in the head or ears, which can be a strange phenomenon for those experiencing it. Some people also claim to hear whooshing sounds and sounds no one else can hear but themselves.

Similarly, high blood pressure, or hypertension, is a common yet serious health condition that affects millions of individuals worldwide. According to statistics, about 31% of men and 26% of women have high blood pressure in England alone.¹ In this article, we shall look at whether high blood pressure could cause pulsatile tinnitus which is important for both patients and healthcare professionals alike.

Understanding blood pressure

Blood pressure is defined as the strength of your blood flow as it pushes against your arteries. High blood pressure can lead to various complications like a stroke, or other heart-related diseases. The high blood pressure range is from 135/85mmHg or more if you take your reading at home, or 140/90mmHg or higher if it is taken by a healthcare professional at a pharmacy, GP surgery or clinic. You can measure your blood pressure yourself by purchasing a blood pressure reading machine which can be bought from most pharmacies or online.

Understanding pulsatile tinnitus 

Causes and mechanisms 

Pulsatile tinnitus could be caused by a change in blood flow in the vessels near the ear or a change in awareness of that blood flow. The blood flow could be affected by:² 

1. Generalised higher blood flow due to intense exercise, pregnancy or a medical condition
2. Localised increased blood flow due to the middle ear artery not closing before the birth of a baby or benign tumours of the head and neck
3. Irregular blood flow due to atherosclerosis, the thickening or hardening of arteries
4. Hearing loss due to perforated ear drums could make you more aware of sounds within your body
5. Idiopathic intracranial hypertension, which is high pressure around your brain due to unknown causes

Diagnosis

It is important to investigate patients with pulsatile tinnitus via radiology to exclude other treatable causes. It is recommended that Computed Tomography angiography (CTA) should be the first line for diagnosing pulsatile tinnitus. It is a scanner that can show high-quality images of your blood vessels and tissues after a contrast material has been injected into your vein. 

Magnetic Resonance Imaging (MRI) should only be used as second-line imaging if no primary cause has been identified. It is a non-invasive process where three-dimensional images of your body are produced by using a magnetic field.³

Is there a connection between pulsatile tinnitus and high blood pressure? 

Research has found that there is a connection between older patients with arterial hypertension – high blood pressure in your arteries – and tinnitus. The results showed that 44.4% of the patients with tinnitus have hypertension compared to 31.4% of patients without tinnitus.⁴ 

According to another study, pulsatile tinnitus can be caused by either your artery or vein.⁵ Since these are blood vessels which carry blood throughout your body, it is safe to assume that blood pressure does affect tinnitus and the rare subgroup of pulsatile tinnitus.

As stated above under the causes of pulsatile tinnitus, idiopathic intracranial hypertension is a risk factor for it. The mechanism behind it is through vibrations which are transferred to fluid in your cochlea causing the persistent sounds of tinnitus.

Atherosclerosis of your carotid artery, which transports blood from your heart to your head, could cause your blood flow to be uneven as there would be thick lumps in your blood vessels that disrupt the smooth flow of your blood. Think of it like how a river flows and hits a big rock, the resistance could cause loud noises similar to the blood in your vessels.

The other artery-related problems causing pulsatile tinnitus are dissecting aneurysms and a rare blood vessel cell disorder called fibromuscular dysplasia (FMD).⁵ 

In addition, abnormal artery and vein formations called arteriovenous fistulas (AVFs) could also cause pulsatile tinnitus. They could be genetic defects or a result of injury or trauma. AVFs have different pressures between the arterial and venous systems which could impact your blood pressure and cause pulsatile tinnitus.⁶ 

The sigmoid sinus is a part of your brain that receives blood from your transverse sinuses. It also may be a reason for pulsatile tinnitus according to research, as when your sigmoid sinus forms a pouch due to an abnormal bone formation, this could result in irregular blood pressure that could cause you to hear pulsing sounds.⁷ 

Managing pulsatile tinnitus 

Most healthcare professionals would be able to identify the reason for your tinnitus. A referral to an otolaryngologist is recommended because pulsatile tinnitus could be caused by another medical problem. Treatment will depend on the cause discovered by your specialist and you will usually be supported by a team of medical professionals. You may need to take medication or have surgery as decided by your specialist. 

There are some treatments not clinically proven to work for pulsatile tinnitus but are suggested such as lowering caffeine intake, cognitive behaviour therapy, tinnitus retraining therapy or sound therapy.⁸ 

By treating blood pressure, you should also be able to reduce your pulsatile tinnitus symptoms. Changing your lifestyle such as exercising, having a healthy diet and managing your stress levels is a good way to start. 

FAQs

How is pulsatile tinnitus different?

It can be identified by feeling your pulse on your neck or on your wrist at the same time as listening to your tinnitus. It is the only type of tinnitus which has the same rhythm as your pulse, although there are other types of tinnitus which have rhythmical sounds. Doctors have a higher chance of finding the main reason behind your pulsatile tinnitus than general tinnitus.⁹

Will I hear sounds in one or both ears?

Usually, pulsatile tinnitus occurs in one ear, but some people can experience it in both ears.¹⁰ 

Summary

Therefore, high blood pressure plays a significant role in pulsatile tinnitus. If you think you have pulsatile tinnitus, you should monitor your blood pressure frequently and seek medical advice. This shows that your cardiovascular health especially around your head and ears is important to prevent the frustrating sounds of pulsatile tinnitus. 

By gaining a detailed understanding of the relationship, you can take proactive steps towards preventing it from happening and improving your quality of life. There is still much research to be done, especially for the rare subgroup of pulsatile tinnitus.