Pulsatile Tinnitus And Sinus Congestion

  • Elinor HobbyBachelor of Sciences in Optometry – BSc(Hons) Optom, Cardiff University, Wales
  • Velamala Sai SudhaDoctor of Pharmacy - Dayananda Sagar College of Pharmacy, Bangalore, India

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Introduction

If you can hear sounds when nothing around you is making noise, you may have tinnitus.1 Having blocked sinuses makes it more likely that a person will get tinnitus. 

This article will discuss the types of tinnitus, its link to blocked sinuses, and the things you can do to manage and prevent these problems.

Tinnitus

As many as 12–30% of people experience tinnitus around the world. It is more common in men than women, and 25% of people with tinnitus have normal hearing when tested.2

Causes of Tinnitus

Tinnitus can be caused by many different problems. These include:1,3

  • Certain medicines (e.g., aspirin, chemotherapy drugs, anti-inflammatory medications, and antibiotics have been known to cause tinnitus)
  • Loss of hearing
  • Depression 
  • Anxiety
  • Meniere's disease (a rare inner ear problem which affects someone's hearing and balance)4
  • Multiple sclerosis (a disease which affects the brain and spinal cord)5
  • Diabetes (a condition which affects a person's blood sugar)6
  • Thyroid problems (where your thyroid gland does not produce the correct amount of messenger chemicals known as hormones)7
  • Benign Intercranial Hypertension (when there is high pressure inside your skull which affects your brain)8
  • Glomus tumour (a harmless growth within the ear)9
  • Problems with the carotid artery (the arteries that bring blood to your brain)10

As well as the above risk factors, a person is more likely to develop tinnitus if:2  

  • They are of a lower class and/or income
  • If they have asthma
  • If they have osteoarthritis
  • If they have lower education

What does Tinnitus sound like?

The sounds people hear when they have tinnitus can be very varied. These can be:1

  • A repetitive whooshing sound which is in time with your heartbeat (pulsatile tinnitus)
  • Music
  • A ringing in your ears
  • Singing
  • Buzzing
  • Hissing
  • Humming

Living with Tinnitus

Tinnitus can have a large impact on someone's everyday life.11

People with tinnitus have reported that their physical and mental health has been negatively affected, as well as their lifestyle, ability to sleep, ability to concentrate, and their ability to hear.11 It can go as far as making people miss school and work, impacting their future and employment.12

When to see your GP

You should make an appointment with your GP if:1

  • Your tinnitus is affecting you when you do everyday activities, e.g., sleeping or working
  • Your tinnitus is there all the time or keeps coming back
  • Your tinnitus is becoming more of a problem over time

Diagnosis

GP Appointment

To diagnose Tinnitus, you will first need to make an appointment with your GP so that they can examine your ear to rule out problems like excess earwax or an infection of the ear.13

Ear, Nose and Throat Examination 

Your GP may refer you on to the Ear, Nose, and Thorat specialists in your local hospital.13 At this appointment, your consultant will examine your ears, head, neck, and shoulders and may arrange for you to have scans.13

Scans

Scans can help your doctor understand what is going on inside your ears. This lets your healthcare team make sure that there is no other cause for the tinnitus, eg. benign intracranial hypertension (see above).13

MRI

An MRI scan uses magnets to create pictures of the inside of your body.14

You will lie on a bed, which will move into the machine.14 It may be loud, so you might be provided with headphones or earplugs.14 The test can take 15–30 minutes and does not hurt.14

Computed Tomography (CT) Scan

CT scans usually take ten to twenty minutes and involve you lying on a bed while the machine moves over the part of your body that is being examined.15

It does not hurt, but you will need to lie still while the machine is taking the images.15

Ultrasound  Scans

During an ultrasound scan, a probe that emits sound waves is touched to your skin. The soundwaves then bounce back and are picked up by the machine and used to build an image.16

Audiology Test

Audiologists measure your hearing level.13 Tinnitus can be caused by physical changes to the ear, e.g., due to benign growths in the ear or due to hearing loss, and so having your hearing checked can help your healthcare team understand the cause.13

When to see your GP

You should make an appointment with your GP if:1

  • Your tinnitus is affecting you when you do everyday activities, e.g., sleeping or working
  • Your tinnitus is there all the time or keeps coming back
  • Your tinnitus is becoming more of a problem over time

Sinus congestion

Sinus congestion is usually caused by an infection, such as a cold.17 It is very common, with one in eight Americans having congested sinuses in their life.18

Sinus congestion symptoms

Congested sinuses can cause many problems, including:18,19

  • Pulsatile tinnitus
  • Dizziness
  • Pain on the face, especially around the nose and eyes
  • Damaged eardrums (a small piece of skin which vibrates due to sound, allowing you to hear),20 possibly leading to perforation (when a small hole is made in the eardrum due to pressure) and/or bleeding
  • Sense of smell being weaker than before

Causes of Sinus Congestion

Sometimes people have a stuffy nose all the time, and no cause can be found. When this is the case, this is called either nonallergic or vasomotor rhinitis.21

Many things do bring on congested sinuses. Some of these causes are:21

  • Smoke from cigarettes
  • Sinusitis (a sinus infection)
  • Thyroid problems
  • Drinking alcohol
  • Sleep apnoea (when the breathing can stop and start while you sleep)
  • If you are allergic to something
  • If you have Respiratory syncytial virus (a virus which can cause infections that affect your breathing)22
  • Churg-Strauss syndrome (a problem that causes inflammation of the blood vessels)
  • If you are pregnant
  • If you are breathing in very cold or very dry air
  • If there is an object stuck in your nose
  • If you have a cold
  • If you have a nasal polyp (a soft growth in your nose which is not normally serious)23
  • If you use nasal spray designed to decongest you too much
  • Medicines treating: seizures, high blood pressure, depression or erectile dysfunction.
  • If you have a deviated septum
  • If you have the flu
  • If you have enlarged adenoids (infection-fighting lumps of tissue that are in the throat)24
  • If you are going through hormone changes
  • Some spicy foods can cause congestion, e.g., curries
  • If you have acid reflux

Diagnosis of Sinus Congestion

Nasal Endoscopy

During this procedure, a camera on a thin, flexible tube is inserted through the nostril. Your doctor will use this to examine your sinuses to see if they are congested.25

Allergy Test

Your doctor may ask for an allergen test to be performed.25 This involves a small sample of many common allergens being put on your skin to see if any of them react.26 This will allow your doctor to know what you are allergic to.

Imaging Tests

Your doctor may request an MRI, CT, or ultrasound scan to examine your sinuses, as discussed in the Tinnitus section of this article.25

Nasal Samples

In rare cases, your doctor may take a small tissue sample from inside your nose to be analysed in a lab to find the cause of your congestion.25

Pulsatile Tinnitus in Sinus Congestion

When the sinuses are congested (full of fluid), this liquid can build up behind the eardrum. This is what causes the whooshing noise that people describe.27

Treating pulsatile tinnitus in Sinus Congestion

The best way to treat pulsatile tinnitus caused by sinus congestion is to treat the congestion.

Treatment options for congested sinuses are:28

  • Using salt water to clean the nose (mix one teaspoon of bicarbonate of soda and one teaspoon of salt into a pint of water that's been boiled and then allowed to cool. While standing over a bath or sink, pour a little of the solution into the palm of a clean hand and inhale to breathe the water into the nostril (be careful not to let it go too far and trickle back through the nose and into the throat). Breathe through your mouth and let the water run out of your nose naturally. You can do this with fresh solution three times per day until your nose starts to feel better
  • Resting as much as possible
  • Do not smoke
  • Drink lots of liquid
  • If you have allergies, avoid the things you are allergic to
  • You can take painkillers according to your doctor or pharmacist's advice

If your sinus problems are caused by a problem like nasal polyps or a deviated septum, this may need to be fixed by surgery.23,29

Asking a local pharmacist for help

If your sinuses are congested, your pharmacist will be able to give you advice on treating it.27 Normally no appointment is needed.

They may recommend:28

  • Medicine to be sprayed up your nose which helps improve the congestion
  • Saline (salt water) sprays, which can clean your nose out for you.

Seeing your GP

Sometimes it is necessary to see a GP to help with your sinuses. Make an appointment with your doctor if:28

  • You keep getting congested sinuses over and over again
  • You feel generally very unwell on top of having congested sinuses
  • If you have had congested sinuses for over three weeks
  • If your sinus congestion keeps getting worse
  • If painkillers do not help

Tinnitus Treatment

Unfortunately, there is no treatment for tinnitus as yet.2 However, cognitive Behavioural therapy has been shown to help people cope with tinnitus.

Cognitive Behavioural Therapy (CBT)

CBT involves having sessions with a counsellor.30

The counsellor will speak to you about the problems you are having and help you to come up with new ways of thinking about and coping with the problems.30 This can help you manage problems like tinnitus more easily and help you keep your life as normal as possible.

Conclusion

Pulsatile tinnitus is more common in people with congested sinuses. Congested sinuses can be treated, usually without the need of help from a GP.

More research is needed on managing tinnitus, though this is a growing field. More findings in the future will help us cope with the problems more effectively.

References

  1. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. Tinnitus. Available from: https://www.nhs.uk/conditions/tinnitus/
  2. Langguth B, Elgoyhen AB, Cederroth CR. Therapeutic approaches to the treatment of tinnitus. Annu Rev Pharmacol Toxicol [Internet]. 2019 Jan 6 [cited 2024 Jul 24];59(1):291–313. Available from: https://www.annualreviews.org/doi/10.1146/annurev-pharmtox-010818-021556
  3. Liyanage SH, Singh A, Savundra P, Kalan A. Pulsatile tinnitus. The Journal of Laryngology & Otology [Internet]. 2006 Feb [cited 2024 Jul 24];120(2):93–7. Available from: https://www.cambridge.org/core/journals/journal-of-laryngology-and-otology/article/abs/pulsatile-tinnitus/7AF2F4DD78C2F914F6FC74B6E3046AFE
  4. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. Ménière’s disease. Available from: https://www.nhs.uk/conditions/menieres-disease/
  5. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. Multiple sclerosis. Available from: https://www.nhs.uk/conditions/multiple-sclerosis/
  6. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. Diabetes. Available from: https://www.nhs.uk/conditions/diabetes/
  7. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. Underactive thyroid (Hypothyroidism). Available from: https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/
  8. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. Intracranial hypertension. Available from: https://www.nhs.uk/conditions/intracranial-hypertension/
  9. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. Neurofibromatosis type 1 - Treatment. Available from: https://www.nhs.uk/conditions/neurofibromatosis-type-1/treatment/
  10. Untitled [Internet]. [cited 2024 Jul 24]. Available from: https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/carotid-artery-disease#:~:text=The%20carotid%20arteries%20are%20major,your%20brain%2C%20causing%20brain%20injury.
  11. Kennedy V, Wilson C, Stephens D. Quality of life and tinnitus. Audiological Medicine [Internet]. 2004 Jan [cited 2024 Jul 24];2(1):29–40. Available from: http://www.tandfonline.com/doi/full/10.1080/16513860410027349
  12. Litvinov J, Spear WC, Patrikeev I, Motamedi M, Ameredes BT. Noninvasive allergic sinus congestion and resolution assessments using microcomputed tomography imaging. Journal of Applied Physiology [Internet]. 2018 Nov 1 [cited 2024 Jul 24];125(5):1563–75. Available from: https://www.physiology.org/doi/10.1152/japplphysiol.00980.2017
  13. What is tinnitus? — causes and treatment | nidcd [Internet]. 2023 [cited 2024 Jul 24]. Available from: https://www.nidcd.nih.gov/health/tinnitus
  14. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. MRI scan. Available from: https://www.nhs.uk/conditions/mri-scan/
  15. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. CT scan. Available from: https://www.nhs.uk/conditions/ct-scan/
  16. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. Ultrasound scan. Available from: https://www.nhs.uk/conditions/ultrasound-scan/
  17. Mayo Clinic [Internet]. [cited 2024 Jul 24]. Acute sinusitis - Symptoms and causes. Available from: https://www.mayoclinic.org/diseases-conditions/acute-sinusitis/symptoms-causes/syc-20351671
  18. Becker DG. Sinusitis. JLT [Internet]. 2003 [cited 2024 Jul 24];13(3). Available from: https://www.dl.begellhouse.com/journals/1bef42082d7a0fdf,23da3e966afd2616,4ea8819c77fa5ec4.html
  19. Morcom S, Phillips N, Pastuszek A, Timperley D. Sinusitis. Family Physician [Internet]. 2016 June [cited 2024 Jul 24];45(6):374-377. Available from: https://search.informit.org/doi/abs/10.3316/informit.138627750386605
  20. Cleveland Clinic [Internet]. [cited 2024 Jul 24]. Ear: anatomy, facts & function. Available from: https://my.clevelandclinic.org/health/body/24048-ear
  21. Mayo Clinic [Internet]. [cited 2024 Jul 24]. Nasal congestion: Sometimes more than just a stuffy nose. Available from: https://www.mayoclinic.org/symptoms/nasal-congestion/basics/definition/sym-20050644
  22. Respiratory syncytial virus (Rsv) :: east lancashire hospitals nhs trust [Internet]. [cited 2024 Jul 24]. Available from: https://elht.nhs.uk/patients/self-care-and-treatments-home/rsv
  23. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. Nasal polyps. Available from: https://www.nhs.uk/conditions/nasal-polyps/
  24. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. Adenoidectomy. Available from: https://www.nhs.uk/conditions/adenoidectomy/
  25. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhin [Internet]. 2020 Feb 1 [cited 2024 Jul 24];0(0):1–464. Available from: https://www.rhinologyjournal.com/Documents/Supplements/supplement_29.pdf
  26. nhs.uk [Internet]. 2017 [cited 2024 Jul 24]. Allergies. Available from: https://www.nhs.uk/conditions/allergies/
  27. London Hearing [Internet]. 2021 [cited 2024 Jul 24]. Pulsatile tinnitus, causes & treatment. Available from: https://www.londonhearing.co.uk/what-is-pulsatile-tinnitus/
  28. nhs.uk [Internet]. 2018 [cited 2024 Jul 24]. Sinusitis(Sinus infection). Available from: https://www.nhs.uk/conditions/sinusitis-sinus-infection/
  29. Newcastle Hospitals NHS Foundation Trust [Internet]. 2021 [cited 2024 Jul 24]. Septal surgery. Available from: https://www.newcastle-hospitals.nhs.uk/services/ear-nose-throat-service-ent/septal-surgery/
  30. nhs.uk [Internet]. 2021 [cited 2024 Jul 24]. Overview - Cognitive behavioural therapy (Cbt). Available from: https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/

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Elinor Hobby

Bachelor of Sciences in Optometry – BSc(Hons) Optom, Cardiff University, Wales

Elinor is an optometrist who has been working in healthcare for many years. She has bolstered her experience with several postgraduate qualifications including Professional Certificate Glaucoma, Professional Certificate in Medical Retina, and Professional Certificate in Low Vision.

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
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