2024-03-16 06:30:00
Tinnitus is a common condition. According to Inserm, around 10% of the adult population suffers from this hearing problem the impact of which varies greatly from one individual to another. Unlike the subjective tinnitus – that is to say only audible to the person concerned – the objective tinnitus can be perceived by a doctor on auscultation or the surroundings and generally result from noises generated by structures close to the inner ear.
Pulsatile tinnitus: definition
Pulsatile tinnitus is defined as the perception of a sound punctuated by heartbeats. « This means that you can hear your heart beating in your ear.confirms Professor Darrouzet. Moreover, if we take our pulse at the same time, we see that it is synchronous with the noise perceived. » This tinnitus may be a sign of turbulence in the blood flow of the carotid artery, jugular vein or arteriovenous malformations.
Breath or feeling of a beating pulse in the ear: what are the symptoms of pulsatile tinnitus?
Pulsatile tinnitus is mainly manifested by perception of the sound of the heartbeat in one ear or, more rarely, in both. “ Everyone sometimes hears their heart beating in their ear when lying down on their pillow because they have a little cardiac erythema, palpitations or are stressed.confides the specialist. On the other hand, when you hear it constantly, while sitting, lying down or standing, it’s a symptom to which one must be attentive and which should prompt consultation. »
Beating in the ear: how is pulsatile tinnitus diagnosed?
The clinical examination and questioning help guide the diagnosis. “ We ask the patient about the intensity of the tinnitus, its permanent nature or not, its evolution over time, if it is influenced by the position of the body: in fact, we can have tinnitus when we are lying down which disappear standing and vice versaexplains Professor Darrouzet. We will also check if the tinnitus is audible to others, as is sometimes the case in dural arteriovenous fistulas. (editor’s note: objective tinnitus). »
The patient will be auscultated in a sitting and lying position, on the ear canal, behind the ear, at the level of the neck and the aortic focus in order to see if the tinnitus has an objective character, to characterize it by its rhythm – systolic or systolic. -diastolic – as well as its timbre: raspy or not. “ We can also do a very simple test by exerting pressure on the occipital artery: if pressing on it reduces or even makes the pulsatile tinnitus disappear – this is what I call the sign “stop” – it is probably tinnitus caused by an arteriovenous fistula. Patients say: that’s it, I can’t hear it anymore! There, treatment by an interventional neuroradiologist must be rapid. »
The doctor will also look for accompanying signs – dizziness, deafness when pressure is applied, balance disorders, pain in the ear, neck or even symptoms related to the cranial nerves – and will examine the eardrum.
Finally, the clinical examination can be completed by a audiogramme as well as by imaging examinations if necessary: CT angiography or brain MRI.
Why do I hear my heart beating in my right (or left) ear? What causes pulsatile tinnitus?
Dural arteriovenous fistulas, benign ear tumors, malpositions of arteries and veins or otospongiose : the causes of pulsatile tinnitus are numerous and the diagnosis complex. “ To understand the principle of pulsatile tinnitus, we must first recall some principles of anatomyexplains Professor Darrouzet. The carotid artery enters the skull through the carotid canal, located in the rock (temporal bone) where the inner ear is located. It’s a bit like a house: in the basement are the water and gas supplies as well as the sewers. The gas and water inlets are the arteries that bring oxygen to the brain. The sewers are the veins that carry deoxygenated blood back to the lungs. These blood vessels pass very close to the cochlea and can cause pulsatile tinnitus when they are poorly positioned or when there is an aneurysm. »
Pulsatile tinnitus of venous origin
Venous tinnitus is increased when lying down. « Patients often say: I have to sleep sitting up because when I lie down it is unbearable”, confirms the specialist. This tinnitus is relieved by sitting, by a cushion placed under the neck or by jugular compression. It is not audible with a stethoscope, so it is purely subjective tinnitus.
Pulsatile tinnitus of arterial origin
Unlike venous pulsatile tinnitus, Arterial pulsatile tinnitus is perceptible whatever the position: it can be heard lying down as well as in a sitting or standing position. « It is often relieved by carotid compression but there is no change in the tinnitus, no “stop” sign, compression of the occipital artery », Indicates Professor Darrouzet. This tinnitus may be linked to a malposition of the internal carotid artery.
Arteriovenous tinnitus
Tinnitus of arteriovenous origin is the most severe and dangerous forms. « Indeed, acquired vascular malformations – dural arteriovenous fistula – which cause this type of tinnitus can cause a stroke.says the ENT doctor. Hence the importance of diagnosing them quickly. » This arteriovenous tinnitus is characterized by its somewhat raspy systolo-diastolic noise, is perceptible on auscultation (objective tinnitus) and is relieved by carotid compression as well as by compression of the occipital artery (stop sign).
L’ostopongiose
This disease of genetic origin which affects the bone tissue of the inner ear is very frequently responsible for pulsatile tinnitus.
Meningeal tinnitus and Minor’s syndrome
Pulsatile tinnitus can also be of meningeal origin. “ It happens that dehiscence – that is to say the opening or rupture of a tissue – of the semicircular canal puts the fluid from the inner ear into contact with the meninge, it is then its own brain which we hear beating. » This abnormal exposure of the upper canal to brain beats, called syndrome de Minorevolves over time and is a source of pulsatile tinnitus.
Primary intracranial hypertension
Finally, primary intracranial hypertension which most often affects young women suffering from obesity is also a cause of pulsatile tinnitus. Tinnitus is then bilateral and associated with headaches, visual disturbances, etc.
Nearly 30 to 40% of pulsatile tinnitus is of unknown etiology.
What are the risk factors for developing pulsatile tinnitus?
Obesity in young women head trauma (especially rock), high blood pressure and THEcardiovascular illnesses are risk factors for developing pulsatile tinnitus.
Is pulsatile tinnitus dangerous? Is it serious to hear your heart beating in your ear?
Permanent pulsatile tinnitus should lead you to consult an ENT doctor.
The symptom that should absolutely alert you is when you hear your heart beating in your ear – whatever the position adopted – and those around you also hear it while being nearby, insists Professor Darrouzet.
This so-called objective pulsatile tinnitus is generally a sign of an arteriovenous fistula, that is to say an abnormal communication between the arterial and venous systems. » These anomalies being potentially serious and, remember, a source of stroke, treatment must be rapid.
What are the treatments for pulsatile tinnitus?
Treatment for pulsatile tinnitus will depend on its cause. The majority of pulsatile tinnitus linked to a vascular anomaly will be treated by interventional neuroradiology.. « For example, in the case of an arteriovenous fistula,the interventional neuroradiologist will go up through the arteries to the vein using a microcatheter and seal the fistula, which will stop the pulsatile tinnitus in its trackshe concludes. In the case of venous malpositions, it is possible to place a stent. »
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