Man suffering from Pulsatile Tinnitus.

Know how when you’re really scared, it can feel like all you can hear is your own heartbeat?

Part of that’s simply perception: Say your friend convinced you to try skydiving and, despite your lifelong fear of heights, you agreed. The instructor might be right there, yelling directions at you, and air could be rushing past the plane’s open door, but it seems like all you can hear is your own heartbeat.

But there’s physiology at work there, too. The carotid and jugular veins go right past our ears, and so that thumping noise you might hear when you’re frightened is very real–you are actually listening to the blood rushing through your veins. Though that noise is always there, when your adrenaline’s pumping and your heart rate is up, your ears will conduct that sound more strongly.

For an estimated five million Americans, that sensation of hearing a rhythmic heartbeat or whooshing sound isn’t limited to specific situations–they hear it all the time. This condition is known as pulsatile tinnitus. This is a variation of tinnitus where instead of hearing a continuous ringing in the ear, the person hears a rhythmic sound. Because it’s the sound of their own blood flowing, this kind of tinnitus is referred to as objective tinnitus–you can hear the sound, and a hearing specialist can hear it, too. (Most forms of tinnitus are subjective tinnitus, meaning the sufferer can hear the sound, but it’s not audible to others.)

What Causes Pulsatile Tinnitus?

When pulsatile tinnitus is temporary, there’s usually an obvious and immediate cause. Too many cups of coffee, a horror movie that looked campy but turned out to be legit scary, or one of your kids yelling, “Mom, dad, look what we found in the basement!”

But when it’s a constant pulsing in your ears, pulsatile tinnitus should be checked out by a hearing specialist. Like other forms of tinnitus, it’s not a disease but a symptom; diagnosing and treating the cause of pulsatile tinnitus can help alleviate the symptom. Here are some things that have been associated with pulsatile tinnitus (there are many more, but this gives you the idea):

Depression and/or anxiety: An estimated 60% of people who suffer from pulsatile tinnitus have issues with chronic depression and/or anxiety, and because tinnitus can exacerbate these conditions, it can create a feedback loop.

High blood pressure: Though temporary factors (like that extra cup of joe) can elevate blood pressure, chronic hypertension is linked to a myriad of serious diseases and conditions. Pulsatile tinnitus could be a tip-off to a significant health issue.

Atherosclerosis: Hardening of the arteries isn’t limited to the heart, though that’s usually what we associate with this condition (think bypass surgeries). But when veins close to the ear become less elastic, you’re more likely to hear your blood flowing. Both atherosclerosis and stenosis (narrowing of the arteries) make your heart work harder to circulate your blood, and that more forceful pumping is also more likely to be audible.

Malformations or tumors: In some cases, pulsatile tinnitus may be caused by malformed connections between arteries and veins, deformities in the small bones in the middle ear, or by a small blood vessel that has a “pouch” near the eardrum. These are usually left untreated. At the other end of the spectrum, pulsatile tinnitus can indicate the presence of a tumor in the head or neck that’s placing pressure on (and narrowing) a vein, problems with pressure inside the head (like intracranial hypertension or hydrocephalus), or an aneurysm. This latter group of problems is about as serious as health issues can get, and proper diagnosis and intervention are vital.

What Should You Do If You Think You Have Pulsatile Tinnitus?

Though for some people pulsatile tinnitus is debilitating, disrupting sleep and making it difficult to concentrate, for others it’s merely an annoyance–and not something they’d necessarily deem checkup-worthy. But given that pulsatile tinnitus could be a symptom of a serious or even life-threatening condition, if hearing your pulse in your ears is something you’re experiencing all the time–not just when you’re about to ask your boss for a raise–get it checked out.

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