It can be disconcerting to hear your heartbeat whooshing or thumping, over and over, in your ear. The nonstop noise might be irksome but also worrisome — could it be related to pulmonary hypertension (PH)?

Generally referred to as pulsatile tinnitus, hearing your heartbeat in your ears is not directly caused by PH. However, the sound may be a symptom of vascular conditions that affect the heart, veins, or arteries — and it can also be caused by nonvascular conditions or abnormalities.

Hearing your heartbeat constantly can be annoying, distracting, and even anxiety producing, affecting your mental health. Knowing what’s causing this symptom is key to reducing its impact on your daily life. Read on to learn more about the causes and management of pulsatile tinnitus.

What Pulsatile Tinnitus Feels Like

Pulsatile tinnitus is a rare form of tinnitus in which you hear a whooshing, thumping, or throbbing sound, usually in time with your heartbeat. The sound may affect one or both ears, it may come and go or be constant — and it can be distracting and frustrating. One myPHteam member wrote, “I keep hearing my heartbeat in my ear, and it gets annoying. It’s there at least 90 percent of the time. I have trouble concentrating and focusing because of it.” Another member said, “I have the pounding in my right ear.”

The sound in your ear may change in volume or pitch and usually matches the frequency of your heartbeat as it quickens with certain activities, like walking up stairs, then slows.

Pulsatile tinnitus itself is not a condition but rather a symptom of other conditions. If you hear your heartbeat in your ears, talk to your health care provider about what may be causing it. Treating the underlying condition — such as the seven discussed below — is key to getting relief from pulsatile tinnitus.

1. Venous Sinus Stenosis

Some research suggests that venous sinus stenosis is the most common cause of pulsatile tinnitus, both of which mostly affect women, according to an American Heart Association journal called Stroke: Vascular and Interventional Neurology. Venous sinus stenosis occurs when the venous sinuses — channels that drain blood from the head — are narrowed. Venous sinuses run near the ear, and if they’re narrowed, blood flow will not be smooth and may lead to a pulsating heartbeat sound.

Gently pressing on the largest vein on the affected side of the neck may reduce or get rid of the sound, though this temporary solution may not be useful for people hearing a constant heartbeat sound. Be sure to talk with your health care provider before trying any neck compression maneuvers.

People with venous sinus stenosis and pulsatile tinnitus that significantly affects their quality of life may benefit from venous sinus stenting. This minimally invasive procedure involves putting a small tube in the narrowed venous sinuses to relieve pressure and improve blood flow.

2. Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension occurs when a buildup of cerebrospinal (brain and spinal cord) fluid increases pressure around the brain. This can lead to pulsatile tinnitus as well as headaches or vision problems. One possible cause of idiopathic intracranial hypertension is venous sinus stenosis as it reduces the drainage of blood from the brain, raising intracranial pressure.

Idiopathic intracranial hypertension is rare, affecting about 1 in 100,000 people in general. However, it is more common among young females who have obesity (20 in 100,000), according to Cleveland Clinic.

To treat idiopathic intracranial hypertension, a health care provider may recommend losing weight, taking medication, or (for severe cases) having surgery.

3. High Blood Pressure

High blood pressure is a common cause of PH, and high blood pressure in blood vessels near your ears may cause pulsatile tinnitus. For example, high blood pressure in the carotid arteries, which extend from your chest to your head, may be heard as a pulsating sound as blood rushes through.

High blood pressure can be managed with certain lifestyle changes, such as getting regular exercise and following a nutritious diet. In addition, medications may help control blood pressure in various ways, such as relaxing the blood vessels and making the heart beat less forcefully.

4. Atherosclerosis

Atherosclerosis is the buildup of plaque and hardening of the arteries. Excess plaque in the blood vessels that supply the heart can lead to coronary artery disease, a common cause of pulmonary hypertension.

Narrowed arteries due to atherosclerosis can affect blood flow throughout the body, including the head, neck, or ears, producing a whooshing or pulsating sound. And it’s not just in your ears — a health care provider using a stethoscope may also hear a whooshing sound if atherosclerosis affects the carotid arteries.

Lifestyle changes, such as being active, eating healthfully, and avoiding cigarette smoke (either quitting smoking or staying away from secondhand smoke) may help manage atherosclerosis. A health care provider may recommend certain medications like ACE inhibitors or calcium channel blockers to lower blood pressure.

5. Blood Vessel Malformations

Malformed blood vessels near the ears, including tangles of blood vessels and aneurysms, may cause pulsatile tinnitus. For example, arteriovenous malformations (blood vessel tangles) can change blood flow in the area and lead to a pulsating sound in the ears. Arteriovenous malformations are very rare — just 1 in 100,000 people have them, according to Cleveland Clinic.

Treatment for blood vessel malformations depends on the type. Arteriovenous malformations may need to be surgically removed so that blood flow can be redirected to normal blood vessels.

6. Ear Abnormalities

Abnormalities of bones near the ear may cause pulsatile tinnitus. For example, if part of a bony canal in the inner ear is too thin or missing, it can cause you to hear your heartbeat, blood flow, or breathing — a rare condition called semicircular canal dehiscence syndrome. Thin or missing bones near the main veins and arteries that run by the ear also may cause you to hear your heartbeat.

Semicircular canal dehiscence syndrome may be treated with surgery to plug the canal and limit fluid movement, which in turn should help with hearing and balance issues.

7. Middle Ear Tumors

Rare tumors called glomus tumors can cause pulsatile tinnitus for two reasons: They’re commonly located near the middle ear, and they can be very vascular, with a lot of blood flowing through. Although they grow slowly, glomus tumors may press on blood vessels in the neck and head, changing blood flow and causing you to hear your heartbeat.

Because these tumors are noncancerous, they may not require treatment. However, if a glomus tumor leads to balance or hearing problems, such as constant pulsatile tinnitus, a health care provider may recommend a procedure to remove the tumor.

Other Causes

Although many causes of pulsatile tinnitus are vascular or directly related to the ear, other types of conditions may also produce this symptom. These conditions include:

• Anemia
• Trauma to the head
• Paget’s disease (a chronic bone disease that may affect the skull)
• Hyperthyroidism (an overactive thyroid)

Occasionally, pulsatile tinnitus resolves on its own, but it’s always best to tell your doctor about this symptom.

Talk With Your Health Care Provider About Management

Dealing with pulsatile tinnitus can feel like an added burden when you’re already living with pulmonary hypertension, but help is available. If you hear your heartbeat in one or both ears, talk with your health care provider about potential causes and how they can be managed. It’s important to treat the condition behind this symptom for your overall health and to potentially alleviate pulsatile tinnitus.

Talk With Others Who Understand

On myPHteam, the social network for people with pulmonary hypertension and their loved ones, more than 50,000 members come together to ask questions, give advice, and share their stories with others who understand life with PH.

Do you hear your heartbeat in one or both of your ears? How do you manage this symptom? Share your experience in the comments below, or start a conversation by posting on your Activities page.