Why Can I Hear My Heartbeat in My Ear? Pulsatile Tinnitus Explained

If you can hear a steady thump, whoosh, or rhythmic beat in your ear that seems to keep time with your heart, you are noticing something that has a name: pulsatile tinnitus. It can be unsettling, particularly the first time it happens, and it is natural to wonder whether it signals something serious. For most people it does not. Pulsatile tinnitus is usually harmless. It is, however, one of the few types of ear noise that can point to an identifiable physical cause, which is why it is worth understanding what it is, why it happens, and when it is sensible to have it looked at.

This guide walks through all of that in plain terms.

What is pulsatile tinnitus?

Pulsatile tinnitus is a rhythmical sound that usually beats at the same rate as your heart. You can often confirm it yourself by feeling your pulse at your wrist or neck while you listen: if the sound rises and falls in time with each beat, it is pulsatile.

This sets it apart from ordinary tinnitus, which most people describe as a steady ringing, buzzing, or hissing that does not follow the rhythm of the pulse. Ordinary tinnitus tends to be a continuous background noise. Pulsatile tinnitus, by contrast, is the sound of a rhythm.

The reason for that rhythm is straightforward. Pulsatile tinnitus is usually caused by a change in blood flow, or a change in your awareness of that blood flow, in the vessels near your ear. In other words, you are hearing something happening inside your own head rather than a sound coming from outside.

Tinnitus in general is very common. Around 1 in 10 adults in the UK experience persistent tinnitus of some kind, and you can read more about the condition as a whole in our complete guide to tinnitus. Pulsatile tinnitus is a smaller subgroup within that, but it is a well recognised and well understood one.

Why can I hear my heartbeat in my ear?

Under normal conditions, blood flows smoothly and silently through the vessels around your ear, and you never notice it. You begin to hear it when one of two things changes.

The first is turbulence. When blood flow becomes faster or less smooth, it can produce a sound that you perceive in time with your pulse. Anything that makes blood move more forcefully or through a narrower or altered channel can create this effect.

The second is heightened awareness. Sometimes the blood flow itself has not changed much at all, but your auditory system becomes more attuned to the normal, quiet sounds of blood moving near the ear. This can happen, for example, when a temporarily blocked ear removes the everyday background noise that would usually mask it, leaving the sound of your own circulation more noticeable than usual.

Everyday factors can also increase blood flow enough to make it audible for a while. Strenuous exercise and pregnancy both raise the volume and speed of blood moving through the body. So can conditions such as significant anaemia or an overactive thyroid. In situations like these, the sound reflects the body working harder rather than anything wrong with the ear itself.

What causes pulsatile tinnitus?

Most causes of pulsatile tinnitus are vascular, meaning they relate to the arteries and veins near the ear. Clinicians generally group them into three categories based on where the sound is generated: arterial, venous, and arteriovenous, which is a combination of the two. The reassuring point to hold onto is that the majority of these causes are benign, and unlike ordinary tinnitus, they can often be identified and, where needed, treated.

Arterial causes

Arterial causes tend to involve narrowing or changes in the artery wall. These include atherosclerosis, which is a hardening and narrowing of the arteries, along with narrowing of the carotid artery, a tear in the artery lining known as a dissection, and a condition called fibromuscular dysplasia. Narrowing of the carotid artery is among the more common findings.

Venous causes

Venous causes relate to the veins that drain blood from the head. One of the more frequently identified is idiopathic intracranial hypertension, a condition involving raised pressure in the fluid around the brain. It is more commonly seen in younger and middle aged women who are overweight, and it is often accompanied by headaches and disturbances in vision.

Arteriovenous causes

Arteriovenous causes involve a direct or abnormal connection between arteries and veins. These include arteriovenous malformations and fistulae, as well as certain vascular tumours of the head and neck, most of which are benign.

Alongside these, some cases relate to the body as a whole rather than a single vessel. Anaemia, an overactive thyroid, and pregnancy can all increase blood flow generally and bring on pulsatile tinnitus in the process.

Because these causes differ so much in nature, and because some are more significant than others, an assessment is the reliable way to know which one applies to you.

Does buzzing in the ear mean high blood pressure?

This is a common worry, and the honest answer is a measured one.

Raised blood pressure can be associated with pulsatile tinnitus, and in some people it may contribute to the sound or make it more noticeable. That said, hearing a noise in your ear is not a reliable way to diagnose high blood pressure on your own. Blood pressure is best confirmed with an actual measurement rather than inferred from a symptom.

It is also worth drawing a gentle distinction. A steady buzz or ring that does not keep time with your heartbeat is more commonly ordinary tinnitus, which is not specifically a blood pressure signal. The heartbeat synchronised whoosh of pulsatile tinnitus is the type more commonly associated with blood flow and vascular factors, which is the category blood pressure belongs to. So while a rhythmic, pulse timed sound may sometimes relate to blood pressure, a continuous buzz usually does not.

The sensible takeaway is simple: if you are concerned about blood pressure, it can be checked easily and directly, and that is a far better guide than the sound itself. For a closer look at the relationship between blood pressure and tinnitus, it is worth exploring the topic on its own.

Is a whooshing sound in the ear dangerous?

For most people, the whooshing sound of pulsatile tinnitus is not dangerous. The majority of causes are benign. What makes pulsatile tinnitus a little different from ordinary tinnitus is that it usually has a specific, identifiable cause rather than no clear source at all. That is precisely why it is worth having assessed: an assessment either uncovers something treatable or provides genuine reassurance that all is well.

National guidance from NICE recommends that everyone with pulsatile tinnitus is offered imaging to investigate the cause. This is not a sign that something serious is assumed, but rather a reflection of the fact that pulsatile tinnitus can usually be traced to a source, and imaging is how that source is found.

When to seek urgent help

While most cases are not urgent, there are specific situations that warrant prompt medical attention. You should seek immediate help if your ear noise occurs alongside any of the following:

• Sudden significant neurological symptoms, such as weakness in the face, or any signs that could suggest a stroke
• Sudden and severe dizziness or a spinning sensation (vertigo)

You should seek urgent assessment, within 24 hours, if you develop tinnitus together with hearing loss that has come on suddenly, over a period of three days or less, within the past month.

These situations are uncommon, but knowing them means you can act quickly in the rare event they apply, and relax a little in the far more likely event that they do not. If it is the whooshing quality of the sound that concerns you most, we look specifically at whether a whooshing sound in the ear is dangerous in more detail elsewhere.

How is pulsatile tinnitus diagnosed and treated?

An assessment for pulsatile tinnitus usually begins with a detailed history and a physical examination. The clinician will pay particular attention to your eardrums and to the blood vessels of your neck, sometimes listening over the neck to check the character of the sound. A hearing assessment is a standard part of the process, and where appropriate, imaging is used to investigate the underlying cause.

Treatment depends entirely on what is found. Where there is an identifiable physical cause, treating that cause can resolve the pulsatile tinnitus altogether. Where no treatable cause is identified, the focus shifts to managing the tinnitus itself and reducing the impact it has on daily life, so that it becomes less intrusive over time. If you would like to understand how audiologists diagnose tinnitus and who is best placed to help, that is covered in full separately.

When should you see a specialist about hearing your heartbeat?

Hearing your own heartbeat in your ear is, for the great majority of people, a benign experience with an explainable cause. But because pulsatile tinnitus is the type of ear noise most likely to have a genuine, findable source, having it properly assessed is one of the more worthwhile things you can do. A good assessment does one of two things, and both are valuable: it identifies a cause that can be addressed, or it confirms that there is nothing to be concerned about and helps you move forward with confidence.

If the sound is persistent, or simply if it is on your mind, a professional assessment is the clearest path to an answer. When you feel ready, you can book a tinnitus assessment in London and have the sound looked at properly.