Free Guide to Understanding Ear Pulsations and Causes

What Are Ear Pulsations and Why They Happen

Ear pulsations, often called pulsatile tinnitus, are sounds you hear that beat in rhythm with your heartbeat. Instead of a constant ringing or buzzing, you hear a whooshing, thumping, or clicking sound that pulses in time with your pulse. This experience affects roughly 3 percent of people with tinnitus, making it less common than other forms of ear noise but still a condition many people experience.

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The key difference between pulsatile tinnitus and regular tinnitus is the rhythmic pattern. When you press your finger against your neck or ear, you might notice the sound matches your heartbeat exactly. This happens because blood flow changes or turbulence near the ear can create vibrations that travel to your inner ear structures, where they get picked up by hearing mechanisms and perceived as sound.

Several normal circumstances can cause temporary pulsations in your ears. Intense exercise, anxiety, fever, or dehydration can all increase blood flow and make your heartbeat more noticeable in your ears. Caffeine, nicotine, and certain medications also boost circulation and may trigger these sounds. For most people, these causes are temporary and resolve once the triggering factor is removed.

The anatomy involved includes blood vessels surrounding the ear canal and middle ear space. When blood moves faster than normal through these vessels, or when vessel walls vibrate abnormally, the sound transmits into your ear canal. Your inner ear's sensory cells pick up this vibration and send signals to your brain, which interprets them as sound.

Practical takeaway: If you experience ear pulsations, note whether they match your heartbeat, what you were doing when they started, and whether they come and go. This information helps when discussing your symptoms with a healthcare provider.

Common Medical Causes of Pulsatile Tinnitus

Certain medical conditions create conditions where blood vessel changes produce ear pulsations. High blood pressure, or hypertension, is one of the most frequent causes. When blood pressure rises, blood moves more forcefully through vessels, including those near the ear. Studies show that people with high blood pressure report pulsatile tinnitus at higher rates than those with normal blood pressure readings.

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Atherosclerosis, a condition where plaque builds up inside arteries, can create turbulent blood flow that produces audible pulsing sounds. As arteries narrow, blood must move faster to get through, creating vibrations similar to water rushing through a partly blocked pipe. People with atherosclerosis risk factors—such as age over 55, smoking history, high cholesterol, or family history of heart disease—may be more likely to develop pulsatile tinnitus.

Venous conditions also cause these sounds. Idiopathic intracranial hypertension (IIH) involves increased pressure in the fluid surrounding the brain and spinal cord. This pressure affects blood vessels in the head and ears. IIH occurs more commonly in women of childbearing age and those with obesity, though it can affect anyone. Symptoms often include headaches alongside ear pulsations.

Anemia, a condition where your blood lacks enough red blood cells to carry oxygen efficiently, forces your heart to pump harder to deliver oxygen throughout your body. This increased pumping makes heartbeats more forceful and noticeable, particularly in areas near the ears. Anemia develops for various reasons including nutritional deficiencies, chronic bleeding, or bone marrow disorders.

Ear or sinus infections can cause temporary pulsations by creating inflammation and fluid buildup that affects normal ear function. Infections increase local blood flow to fight the infection, which may produce audible pulsing. Middle ear infections (otitis media) create particular vulnerability because the middle ear space sits directly behind the eardrum with blood vessels running through it.

Thyroid disorders, particularly hyperthyroidism where the thyroid produces excess hormone, speed up metabolism and heart rate. This increased cardiovascular activity makes pulsations more noticeable. Thyroid conditions affect roughly 12 percent of Americans at some point in their lives, with higher rates in women and older adults.

Practical takeaway: Keep a symptom diary noting when pulsations occur, any associated symptoms (headaches, vision changes, shortness of breath), and whether you have risk factors for conditions like high blood pressure or anemia. Share this with your healthcare provider.

Structural and Vascular Problems That Create Pulsations

Certain structural abnormalities in blood vessels near the ear can directly cause pulsatile tinnitus. An arteriovenous fistula (AVF) is an abnormal connection between an artery and vein that bypasses normal capillaries. This allows high-pressure arterial blood to flow directly into veins, creating turbulent flow and vibration. AVFs can develop from injury, surgery, or rarely, as a congenital condition present from birth. They occur in roughly 1 to 2 per 100,000 people annually.

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Arteriovenous malformations (AVMs) are tangles of blood vessels where arteries connect abnormally to veins. These malformations are often congenital but may not cause symptoms until later in life. The irregular vessel pathways create chaotic blood flow patterns that can produce pulsatile sounds. Brain or spinal cord AVMs might affect vessels near the ear.

Carotid artery dissection involves a tear in the inner layer of the carotid artery, which supplies blood to the brain and head structures. This tear allows blood to pool within the artery wall, narrowing the vessel opening and causing turbulent flow. Dissections can result from trauma, sudden neck movements, or spontaneously in people with connective tissue disorders. They affect roughly 2 to 3 people per 100,000 annually.

Stenosis, or narrowing of blood vessels, creates increased velocity and turbulence in blood flow, similar to water pressure increasing when a hose is pinched. Carotid stenosis and jugular vein stenosis both can cause pulsatile tinnitus. These conditions develop gradually through atherosclerosis or acutely from blood clots. Roughly 7 percent of men and 5 percent of women over age 65 have significant carotid artery stenosis.

Glomus tumors are benign growths of blood vessels that can develop near the ear. The increased blood vessel activity in these tumors creates noticeable pulsations. Glomus tympanicum tumors grow in the middle ear space, while glomus jugulare tumors develop in jugular vein tissue. These tumors are rare, affecting fewer than 1 in 100,000 people, but they frequently produce pulsatile tinnitus as a main symptom.

Pulsatile tinnitus after head or neck trauma can indicate vessel damage or internal bleeding. Even mild injuries may cause vascular changes that produce pulsations. If you develop pulsatile tinnitus following any head or neck injury, getting medical evaluation is important to rule out serious complications.

Practical takeaway: If your pulsations developed after an injury, during pregnancy, or with other neurological symptoms like vision changes or balance problems, mention this timing to your healthcare provider as it may suggest vascular causes requiring imaging studies.

Less Serious Causes and Benign Explanations

Many cases of pulsatile tinnitus have benign causes that resolve without treatment. Eustachian tube dysfunction, where the small tube connecting your middle ear to your throat doesn't open and close properly, can cause awareness of your heartbeat in your ears. This tube normally allows air pressure to equalize. When it malfunctions, fluid accumulates and you become more aware of normal blood vessel vibrations. Eustachian tube dysfunction affects roughly 5 percent of adults at any given time.

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Earwax impaction can contribute to pulsatile sensations. Excess earwax buildup changes how sound travels through your ear canal and may amplify internal vibrations from blood vessels. This common condition affects about 1 in 20 adults regularly and up to 1 in 3 older adults, making it one of the most frequent ear complaints.

Pregnancy causes significant cardiovascular changes including increased blood volume and heart rate to support the developing fetus. Blood volume increases by 30 to 50 percent during pregnancy,