Pulsatile Tinnitus And Pregnancy

  • Aditi Shingal Master of Science (M.Sc.), Biomedical Sciences, The University of Edinburgh

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Overview

Tinnitus, characterised by the perception of sound without an external source, affects a significant portion of adults around the world. During pregnancy, a common form of tinnitus is Pulsatile Tinnitus, distinguished by rhythmic noises like thumping or whooshing. This condition can disrupt sleep, impair concentration and impact overall well-being, potentially leading to heightened anxiety or depression in severe cases.

This article provides comprehensive insights into the definition, symptoms and common causes of pulsatile tinnitus during pregnancy. It explores diagnostic approaches and effective management strategies aimed at alleviating symptoms and enhancing the quality of life for affected individuals. Additionally, it highlights the crucial role of counselling and support in addressing the emotional distress associated with this condition during pregnancy.

While pulsatile tinnitus during pregnancy often resolves after childbirth, its impact on pregnant women should not be underestimated. Thus, this article aims to empower pregnant individuals by offering knowledge and understanding of the condition, enabling them to seek appropriate assistance and support as needed.

Pulsatile tinnitus

Pulsatile tinnitus is defined by rhythmic sounds such as thumping, whooshing, or throbbing in the ears, often in rhythm with the individual's heartbeat. It can indicate underlying cardiovascular issues like heart problems or blood vessel disorders. While some people with pulsatile tinnitus may find it mildly bothersome, others may struggle to concentrate or sleep due to its disruptive nature.1

Compared to other types of tinnitus, pulsatile tinnitus is less common. It directly stems from abnormalities in blood circulation, resulting in rhythmic noises resembling heartbeat sounds. These noises arise from changes in blood flow throughout the body, possibly due to factors like narrowed or abnormal blood vessels, turbulent blood flow or increased blood volume. In contrast, other forms of tinnitus originate from the brain's misinterpretation of sounds due to issues within the auditory system, such as inner ear damage or nerve problems.

Pulsatile tinnitus during pregnancy

Pulsatile tinnitus affects approximately 1 in 3 pregnant individuals, often described as hearing a heartbeat in the ear, accompanied by reduced hearing, plugged ears and loud continuous hissing. These symptoms primarily stem from hormonal and circulatory changes during pregnancy but can also result from several medical conditions detailed below.

Symptoms

Pulsatile tinnitus stems from irregular blood flow dynamics in the arteries or veins near the ears, resulting in an audible perception of the heartbeat. This condition presents as a rhythmic sound, often resembling a steady beat or whooshing noise, synchronising with the individual's heartbeat. However, it can also manifest as buzzing, roaring, clicking, hissing, or humming. 

Unlike typical heartbeat sounds, individuals with pulsatile tinnitus may perceive this sound even without exertion. Symptoms may worsen at night when external noises are minimal, significantly impacting sleep and daily life due to their distracting and loud nature. 

Additionally, pulsatile tinnitus may occasionally be accompanied by other symptoms, including 

  • headaches 
  • dizziness 
  • vision problems
  • hearing loss

Common causes of pulsatile tinnitus

Pulsatile tinnitus can arise from various underlying factors. These are all briefly discussed below,

Blood flow Issues

Pulsatile tinnitus occurs when the ear detects a change in blood flow in nearby blood vessels, which include the arteries and veins in the neck, the base of the skull and the ear itself.

  • Increased blood flow

Activities like intense exercise or health conditions like anaemia can make blood flow louder, causing noise.

  • Turbulent blood flow 

Hardened arteries or high blood pressure can create noisy turbulence in blood flow.

  • Ear and head abnormalities
    • Tumours or abnormalities in the head and neck. These can disrupt blood vessel development and cause pulsatile tinnitus.
    • Sinus problems. Issues like sinus infections or abnormalities can create pressure changes, leading to noise.
  • Other factors
    • Stress and sleep problems. Pregnancy-related stress or sleep disturbances can worsen tinnitus symptoms.
    • Medications. Some drugs, especially at higher doses, can make pulsatile tinnitus worse.
    • Health conditions. Certain chronic conditions like thyroid issues or autoimmune disorders have been linked to pulsatile tinnitus.

Risk factors associated with pulsatile tinnitus

Risk factors associated with pulsatile tinnitus include

  • High blood pressure and preeclampsia
  • Exacerbation of pre-existing tinnitus
  • Anxiety or depression
  • Maternal well-being and quality of life

High blood pressure and preeclampsia

Pulsatile tinnitus can serve as a warning sign of high blood pressure and preeclampsia in some pregnant women, highlighting the importance of monitoring symptoms for timely detection and management.

Exacerbation of pre-existing tinnitus 

During pregnancy, about two-thirds of individuals with pre-existing tinnitus experience a worsening of their symptoms, typically occurring around four to six months of gestation. This exacerbation can contribute to increased discomfort and challenges in managing the condition during this period. In severe cases, it can also lead to hearing loss or dizziness, adding further concern to the impact of tinnitus during pregnancy.

Anxiety or depression

Experiencing pulsatile tinnitus during pregnancy can trigger feelings of anxiety and depression due to the disruptive nature of the condition on sleep, concentration and daily activities. Uncertainty about its implications for maternal and foetal health can further exacerbate emotional distress, highlighting the need for comprehensive support and intervention strategies.

Maternal well-being and quality of life

Pulsatile tinnitus significantly impacts pregnant women's well-being by causing heightened stress, anxiety and sleep disturbances. This constant perception of pulsing sounds interferes with daily activities and social interactions, exacerbating feelings of frustration and isolation. These challenges are compounded by the unique emotional and hormonal changes of pregnancy, amplifying the effects of tinnitus on maternal mental health. 

Foetal development and pregnancy outcomes 

Research specifically focusing on the direct impact of pulsatile tinnitus on foetal development is limited. However, maternal stress and anxiety associated with the condition can indirectly affect pregnancy outcomes. 

High levels of stress hormones may be involved. For example, cortisol circulating in the maternal bloodstream may cross the placenta, potentially impacting foetal development and increasing the risk of adverse outcomes such as preterm birth or low birth weight. 

Chronic stress during pregnancy has also been linked to complications like gestational hypertension and preeclampsia, negatively affecting both maternal and foetal health. 

Additionally, stress and sleep disturbances, often exacerbated by tinnitus, can further compound these risks. 

Diagnosis of pulsatile tinnitus in pregnant women

To diagnose pulsatile tinnitus, healthcare providers employ various methods to assess the symptoms and potential underlying causes:2

Initial evaluation

  • Medical history review 

Physicians inquire about symptoms, medical history and medications that might influence tinnitus.

  • Physical examination

Examination of the ears, head, neck, and eyes helps identify any visible issues or signs of increased pressure inside the head.

Hearing tests

  • Hearing assessment

Hearing tests are conducted to assess hearing loss and distinguish sounds from within the body, audible to only the patient.

Imaging studies

  • Radiographic imaging

Various imaging tests, such as MRI, CT scan, angiography and ultrasound, provide detailed images of the head, neck, and blood vessels to detect structural abnormalities or vascular issues associated with pulsatile tinnitus.

Additional tests

  • Blood tests

Screening for conditions like anaemia or thyroid disorders that may contribute to tinnitus.

Seeking a thorough evaluation by an otolaryngologist familiar with pulsatile tinnitus is essential for accurate diagnosis and appropriate management. If pulsatile tinnitus is suspected, prompt medical attention ensures timely intervention and the exclusion of serious underlying causes.

Management and treatment options

Pulsatile tinnitus may resolve spontaneously after. When it persists, successful treatment and cure are often achievable once the underlying cause is determined. Given its potential association with serious medical conditions, individuals experiencing pulsatile tinnitus should undergo a comprehensive medical assessment. 

When managing pulsatile tinnitus during pregnancy, a range of management and treatment3 options are available, including lifestyle adjustments, therapeutic interventions, audiological support, and other targeted approaches to effectively alleviate symptoms.

Consult healthcare professionals

  • Seek personalised advice from an obstetrician on managing pulsatile tinnitus symptoms during pregnancy.
  • Address underlying conditions contributing to pulsatile tinnitus, such as anaemia or ear infections, with guidance from healthcare providers.

Lifestyle modifications

  • Manage stress levels by practising relaxation techniques like meditation or yoga.
  • Maintain a healthy diet rich in fruits, vegetables, and whole grains, and stay hydrated.
  • Engage in gentle exercise like walking or prenatal yoga to enhance blood circulation and reduce stress.

Avoid triggers

  • Educate yourself on pulsatile tinnitus and identify and avoid potential triggers like stress or loud noises.
  • Protect your ears in noisy environments by using ear protection like earplugs or earmuffs.

Therapy-based interventions

  • Explore sound therapy or cognitive behavioural therapy to mask tinnitus sounds and address associated anxiety.
  • Consider tinnitus retraining therapy to habituate the brain to tinnitus sounds over time.

Audiological support

  • Consult an audiologist for personalised treatment options and recommendations.
  • In severe cases, consider hearing aids or sound-masking devices for relief.

Other interventions

  • Discuss medication options with healthcare providers after considering potential risks during pregnancy.
  • Evaluate surgical interventions for specific underlying conditions carefully, especially during pregnancy.
  • Explore alternative therapies like acupuncture under healthcare provider guidance.

Counselling and support

  • Seek counselling to address emotional distress associated with pulsatile tinnitus during pregnancy.
  • Healthcare providers play a crucial role in providing ongoing support, and guidance, and ensuring women feel understood throughout their journey.

Integrating these strategies into the treatment plan improves overall well-being and quality of life during pregnancy for women experiencing pulsatile tinnitus.

Summary 

Pulsatile tinnitus is a condition characterised by rhythmic ear noises. Individuals suffering from the condition during pregnancy can suffer from disrupted sleep, focus and overall health, potentially affecting foetal development and pregnancy outcomes. 

Effective management of pulsatile tinnitus is crucial for maternal and foetal well-being, with healthcare providers offering diverse treatment options. Prioritising the health of pregnant individuals with pulsatile tinnitus involves timely interventions, lifestyle adjustments, and therapy-based approaches. Counselling and support are essential for addressing emotional distress. 

By seeking assistance and implementing strategies, pregnant individuals can enhance their quality of life, benefiting their health and that of their developing foetus.

References

  1. Salazar JW, Meisel K, Smith ER, Quiggle A, McCoy DB, Amans MR. Depression in patients with tinnitus: a systematic review. Otolaryngol--head neck surg [Internet]. 2019 Jul [cited 2024 Mar 9];161(1):28–35. Available from: https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599819835178
  2. Lenkeit CP, Al Khalili Y. Pulsatile tinnitus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Mar 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK553153
  3. Pegge SAH, Steens SCA, Kunst HPM, Meijer FJA. Pulsatile tinnitus: differential diagnosis and radiological work-up. Curr Radiol Rep [Internet]. 2017 Jan [cited 2024 Mar 9];5(1):5. Available from: http://link.springer.com/10.1007/s40134-017-0199-7

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Aditi Shingal

Master of Science (M.Sc.), Biomedical Sciences, The University of Edinburgh

Aditi Shingal is a Science and Health writer with a background in Pharmacy and a Research Masters in Genomics from the University of Edinburgh. She is passionate about health advocacy and crafting compelling scientific narratives for a diverse audience. Aditi strives to navigate the intersection of science, technology, and humanity with care and diligence. Balancing roles as a devoted mother, doting dog parent, and seasoned pharmacist, Aditi’s portfolio extends across various domains including science, health, pets, travel, productivity, and parenting, showcasing her versatility and depth of knowledge.

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