Pulsatile tinnitus: why it needs a doctor's assessment

Pulsatile tinnitus is a rhythmic sound, often a whoosh or a thump, that beats in time with your heartbeat. Unlike ordinary tinnitus, it often has a specific cause in or near the blood vessels around the ear, and that cause can frequently be found. That is why guidelines advise a medical assessment, usually including a scan. Ask your GP for an appointment soon rather than waiting to see if it passes.

Last reviewed: 28 October 2026

By the Tinnitus Haven editorial team. Sources are listed at the end of the page.

This guide is general information, not medical advice. If your tinnitus is new, one-sided, pulsing or comes with hearing loss or dizziness, see a doctor.

What is pulsatile tinnitus?

It is a rhythmic noise in the head or ears that usually pulses at the same rate as your heartbeat. You can often tell by feeling your pulse at the wrist or neck while you listen to the sound^[1]. It is much less common than steady tinnitus: fewer than 10 in 100 people with tinnitus have the pulsatile kind^[2].

Sometimes a doctor can hear the sound too, through a stethoscope. This is called objective tinnitus, and it often has a cause that can be identified and treated^{[3, 1]}.

A rhythmic sound that does not follow your pulse is something different. A clicking or fluttering rhythm can come from small muscles in the middle ear or the palate twitching, and a sound that changes with your breathing can come from the tube that connects the ear and the nose. These are rare and should also be checked by a doctor^[1].

What can cause it?

Pulsatile tinnitus is usually caused by a change in blood flow in the vessels near the ear, or by becoming more aware of that blood flow^[1]. Possible causes include^{[1, 2]}:

faster blood flow through the whole body, for example during hard exercise or pregnancy, or with severe anaemia or an overactive thyroid
turbulent flow where an artery has narrowed or hardened
unusual connections between arteries and veins, or growths near the skull base that are rich in blood vessels; most of these growths are benign
raised pressure inside the head (idiopathic intracranial hypertension), which usually also causes headaches and problems with vision
normal variations in the large veins near the ear
middle ear problems, such as a perforated eardrum, glue ear or an ear infection, which make sounds inside the body easier to hear

Some medicines, including certain blood pressure tablets, have also been linked to pulsatile tinnitus^[2]. Do not stop a prescribed medicine on your own; raise it with your doctor.

This list is not complete, and you cannot tell the cause from the sound itself^[1]. Even after a careful assessment, no cause is found in up to 30 in 100 people^[2].

Why should a doctor check it?

With steady tinnitus a single cause is rarely found. With pulsatile tinnitus, a specific cause is more likely^{[1, 2]}, and some of those causes need treatment. For that reason the NHS advises asking for an urgent GP appointment if your tinnitus beats in time with your pulse^[4], UK guidance recommends offering imaging to everyone with pulsatile tinnitus^[5], and the German guideline asks doctors to check for changes in the blood vessels^[6].

Being referred for a scan does not mean the doctor expects bad news. It is simply the standard way to look for a cause.

What tests might the doctor do?

Questions about when the sound started, which side it is on, your general health and your medicines^{[2, 1]}.
An examination of your ears and eardrums, and listening over your neck and skull with a stethoscope^{[1, 6]}.
A hearing test^{[1, 2]}.
Imaging, chosen to fit your symptoms: for example an MRI or MR angiogram, a CT or CT angiogram, or an ultrasound scan of the blood vessels in your neck^{[1, 5]}.
Blood tests, for example to look for anaemia or an overactive thyroid^[1].

If raised pressure inside the head is suspected, you may also be referred to an eye specialist or a neurologist^[1]. Before the appointment it can help to note when the sound started, whether it is in one or both ears, and any headaches or changes in your vision, and to bring a list of your medicines.

When is it urgent?

Go to an emergency department or call your local emergency number if tinnitus starts after a head injury, or comes with sudden hearing loss, weakness in your face or a spinning feeling^[4], or with other sudden neurological symptoms^[5]. Tell a doctor promptly if the pulsing comes with new headaches or problems with your vision, which can be signs of raised pressure inside the head^[2].

How is pulsatile tinnitus treated?

Treatment depends on the cause the tests find. If there is a physical cause, treating it can help^[1]. Some examples, in general terms:

Faster blood flow from another condition, such as severe anaemia or an overactive thyroid: the underlying condition is treated^[1].
Raised pressure inside the head (idiopathic intracranial hypertension): losing weight if you are overweight, stopping a medicine that may be causing it, and medicines that reduce fluid. Surgery is considered if these do not help, especially when eyesight is at risk^[7].
Changes in the blood vessels, such as a narrowed large vein, an abnormal connection between an artery and a vein, or a small pouch in a vein wall: depending on the risk, specialists may simply monitor it, or treat it from inside the blood vessel (for example with a stent or tiny coils) or with surgery. When the cause is in an artery, treatment usually ends the sound, although the evidence comes mostly from small case series^[8].
A medicine linked to the sound: your doctor can review it with you. Do not stop a prescribed medicine on your own^[2].

Procedures have risks of their own, so the decision is made together with the specialist, weighing the risks of the condition against the risks of treatment^[8]. If no cause is found, or while you wait for tests, the approaches used for other kinds of tinnitus, such as sound therapy, relaxation and CBT, can also help^[1]. See our guides to CBT for tinnitus and tinnitus, stress and anxiety, and our overview of tinnitus treatment options.

Tinnitus Haven brings sound therapy, a hearing check and CBT-based lessons together in one calm iPhone app, coming soon to the App Store. Learn more about Tinnitus Haven.

Sources

Tinnitus UK. Pulsatile tinnitus. 2022.
Hofmann E, Behr R, Neumann-Haefelin T, Schwager K. Pulsatile tinnitus: imaging and differential diagnosis. Deutsches Ärzteblatt International, 2013.
National Institute on Deafness and Other Communication Disorders (NIDCD), NIH. Tinnitus. 2023.
NHS. Tinnitus. NHS website, 2024.
National Institute for Health and Care Excellence (NICE). Tinnitus: assessment and management (NG155), Recommendations. NICE guideline, 2020.
Mazurek B, Hesse G, Sattel H, et al. S3 Guideline: Chronic Tinnitus. German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC). HNO, 2022. English version of the German AWMF guideline 017/064 (2021).
NHS. Intracranial hypertension. NHS website.
Narsinh KH, Hui F, Duvvuri M, Meisel K, Amans MR. Management of vascular causes of pulsatile tinnitus. Journal of NeuroInterventional Surgery, 2022.