Pulsatile Tinnitus Causes & Treatments

Pulsatile Tinnitus (PT) is a symptom that affects nearly five million Americans. The sensation of hearing a rhythmic noise, such as a heartbeat, swooshing or whooshing, from no external source, is, at best, a little unsettling; for many, the near constant sound exceeds annoyance and becomes completely debilitating. Nearly 60% of patients who experience this issue also suffer from some form of depression or anxiety. These rates are significantly higher than those associated with other chronic conditions due in large part to the difficulty of diagnosing the root cause of symptoms. 

Common Causes of Pulsatile Tinnitus

Pulsatile Tinnitus can have many different origins, some fairly benign, others potentially life-threatening. Sources can include vascular malformations, abnormal cerebral pressures, and unique blood flow patterns near the ear. The condition can also be caused by the presence of a tumor. Even when the causes of Pulsatile Tinnitus are fairly benign, its effects are sufficiently incapacitating for most patients to seek help.  

Why Choose Pulsatile Tinnitus Treatment at UCSF

  • Multidisciplinary approach involving specialists from the departments of Radiology, Neurology, and Psychiatry who collaborate to diagnose and treat this condition
  • Strong reputation for resolution despite previous misdiagnosis
  • Active research of Pulsatile Tinnitus to help future patients and outcomes
  • Diagnosis success rate of over 90% 
  • Read One Patient’s Quest to End Ominous Ringing in Her Ear

Diagnosing Pulsatile Tinnitus

Physicians Referrals

For physicians seeking consultation or referrals, please contact us at (415) 502-3895
Please provide us with the following:  PTC Referral Checklist (pdf)

  1. Referral from your physician
  2. Medical records including any pertinent notes regarding your symptoms and imaging reports
  3. Brain/Head/Neck Imaging (CT, MRI/A, PET, etc.), if any, copied to a CD
  4. Patient and insurance demographics (address, contact number and front and back copies of insurance cards)
  5. Insurance authorization for CPT codes:  99205 (evaluation) x2 units
    When required, it is your responsibility to work with your referring physician to obtain prior authorization to your appointment. If your insurance does not require prior authorization please send a note with (call reference number, agent name, phone number, and message). If you have Medicare Part B, we do not need prior authorization.
  6. Please mail or fax to: 
    UCSF Pulsatile Tinnitus Clinic
    505 Parnassus Ave. L308
    San Francisco, CA 94143
    Ph: (415) 502-3895
    Fx: (415) 502-4017
  7. Once all information is received, the referral is carefully reviewed by our team to determine the most appropriate evaluation. Our office will contact patient or family directly within 2-4 weeks for scheduling.

Patients Self-Referrals

Patients can self-refer through the UCSF’s Second Opinion portal (please specify "Dr. Matthew Amans" to review).  This is often preferred by those who:

  1. Seek a second opinion;
  2. Have not yet scheduled an appointment with a doctor regarding this condition.

Schedule a Virtual Consultation

About the Second Opinion program:

  • A review of your case by Dr. Amans, who will communicate his 2nd opinion to you through UCSF’s Second Opinion portal. He will indicate whether he recommends the option to see him in clinic.

How does it work:

  • Through the portal, please specify "Dr. Matthew Amans" to review.
  • You will be asked for all relevant information for Dr. Amans to assist with your consultation.
  • This includes your demographics, a description of your symptoms, and any prior images.
  • With this information, Dr. Amans will be able to reach out to you directly to provide a rapid response to your question regarding your condition next steps.  To access the portal, please visit: UCSF’s Second Opinion portal.

Highlights:

Convenience of PT diagnosis up front, without the need of scheduling an in-person meeting

  1. Determine if you have Pulsitile Tinnitus and what to do about it.
  2. Direct contact with world-leader in the field of Pulsitile Tinnitus.
  3. Quick turn around time.
  4. No need to schedule an in-person appointment for first consultation (diagnosis).

Pulsatile Tinnitus Treatments

Conditions Treated:

  • Dural Arteriovenous Fistula (DAVF): Dural arteriovenous fistula is an abnormal connection between arteries and veins in the head. These can be dangerous and often require treatment by a neurointerventional radiologist using minimally-invasive image-guided catheter-based procedures. UCSF has pioneered many of the treatments for this condition.
  • Carotid Stenosis: Carotid stenosis is an abnormal narrowing of an artery in the neck that carries blood to the brain. This can be dangerous and often requires treatment with medicines or procedures or both to relieve the narrowing. UCSF offers the full range of treatments for this condition, which may include medicines, image-guided procedures, surgical procedures, or a combination of these.
  • Idiopathic Intracranial Hypertension (IIH): Idiopathic intracranial hypertension results in high pressures in the fluid (CSF) surrounding the brain, which causes headaches and high pressure in the eyes. This is usually first treated with weight loss and medicines. However, some patients need to be treated with procedures, such as stenting to improve blood flow out of the head, or other procedures to remove fluid from the head or cause weight loss.
  • Brain Aneurysm: A brain aneurysm is a bubble or bubble-like weakening in a blood vessel (artery) of the brain. Aneurysms can cause pulsatile tinnitus because of abnormal blood flow; they also have the potential to leak or rupture, causing bleeding into the brain or its surrounding space (a type of stroke). UCSF offers the full range of treatments for this condition, which includes monitoring with MRI, image-guided interventions, and surgery. UCSF helps more than 300 patients with brain aneurysms each year, and is actively involved in research into the causes, prevention, and treatment of these diseases.
  • Venous Sinus Stenosis: Venous sinus stenosis is an abnormal narrowing of a vein in the head carrying blood away from the brain. Sometimes these require treatment by a neurointerventional radiologist to treat the abnormal blood flow.
  • Sigmoid Diverticulum: Sigmoid diverticulum is an abnormal outpouching of a vein in the head carrying blood away from the brain. Sometimes these require treatment by a neurointerventional radiologist to treat the abnormal blood flow.
  • High Riding Jugular Bulb: High riding jugular bulb refers to a vein that is abnormally close to the hearing organ. Sometimes this can cause pulsatile tinnitus.

Pulsatile Tinnitus FAQs

How serious is pulsatile tinnitus?

Pulsatile tinnitus is a common symptom that impacts between 3-5 million americans. While the potential underlying diseases are many, only some cary significant risks of intracranial hemorrhage, stroke, or blindness. Therefore, evaluation by a specialists with high levels of experience is recommended. In addition, many patients suffer from their pulsatile tinnitus, and in our experience there I usually an underlying structural cause that may be possible to correct and alleviate symptoms.

How does pulsatile tinnitus differs from regular tinnitus?

Pulsatile tinnitus is a rhythmic sound typically in sync with the heartbeat. It is usually described as a whooshing type of noise (fetal heart beat, crescendo-decrescendo quality). Continuous tone tinnitus is quite separate and not usually vascular.

What is the most common cause of pulsatile tinnitus?

Venous sinus stenosis/IIH is the most common cause of pulsatile tinnitus. Dural arteriovenous fistula is the most potentially dangerous cause of pulsatile tinnitus. Our team are experts in the diagnosis and treatments of all causes of pulsatile tinnitus.

Should I see a doctor for pulsatile tinnitus?

Yes. Unfortunately not all physicians are experienced in pulsatile tinnitus, and referral to a high volume institution such as ours may be needed.

When should I worry about Pulsatile Tinnitus?

Pulsatile tinnitus can be a symptom of a dangerous problem with the blood vessels in the head, but not always. Sometimes, pulsatile tinnitus can signal a more serious impending health problem, like a stroke or blindness. Therefore, pulsatile tinnitus should prompt you to see a doctor to further assist you. Pulsatile tinnitus can also significantly impact your mood, and sometimes needs to be treated for this.

Is Pulsatile Tinnitus an emergency?

That depends on what is causing the pulsatile tinnitus. Some causes need to be treated urgently, but most do not. Understanding what is causing the pulsatile tinnitus is key to determining the best course of action.

What happens if Pulsatile Tinnitus Is untreated?

That depends on what is causing the pulsatile tinnitus. If the pulsatile tinnitus is caused by a dangerous problem with the blood vessels in the head or neck, and it is untreated, blindness or stroke (causing problems with walking, talking, or death) can result. A doctor should help you determine whether your pulsatile tinnitus is dangerous or not, and then you can decide whether to leave it untreated or not.

Billing & Insurance

After a procedure is scheduled, UCSF Interventional Neuroradiology will help patients and referring practices with pre-service insurance authorization or pre-service coverage determination when the patient is referred by a UCSF provider. 

Pulsatile Tinnitus Clinic News

Pulsatile Tinnitus: One Patient’s Quest to End Ominous Ringing in Her Ear

It started in her right ear, a persistent whooshing sound that interfered with sleep and increasingly distracted her from daily activities.
Read more about this pulsatile tinnitus case study.


Society of Neurointerventional Surgery in Boston

July 25-28, 2016

Presentations of four abstracts on pulsatile tinnitus.

Prominent Condylar Veins Causing Pulsatile Tinnitus: Dynamic Angiographic Confirmation

Prominent Condylar Veins Causing Pulsatile Tinnitus: Dynamic Angiographic Confirmation

Turbulent Flow in the Venous Outflow Tract of Pulsatile Tinnitus Patients with Sigmoid Sinus Diverticulum

Turbulent Flow in the Venous Outflow Tract of Pulsatile Tinnitus Patients with Sigmoid Sinus Diverticulum

Venous Blood Flow Visualization in Sigmoid Sinus Diverticulum Using MRI

Venous Blood Flow Visualization in Sigmoid Sinus Diverticulum Using MRI

Jugular Vein Flow Patterns in Patients with Pulsatile Tinnitus Using Computational Fluid Dynamics

Jugular Vein Flow Patterns in Patients with Pulsatile Tinnitus Using Computational Fluid Dynamics

Quantitative Imaging In Medicine and Surgery

September 3, 2015

Abstract

It has not been previously possible to investigate the link between the presentation of flow related symptoms, such as pulsatile tinnitus, and flow patterns (1). In recent years, magnetic resonance imaging (MRI) has able to determine the full velocity field in 3-dimensional (3D) space through the cardiac cycle. We used MR flow imaging in vivo and in vitro with a patient-specific flow model to study the flow patterns in the dominant right sigmoid sinus and jugular vein of a patient who presented with right-sided subjective pulsatile tinnitus which cannot be heard by an examiner auscultating the head.

Pulsatile Tinnitus flow patterns MRI

ASHNR 2015

April 13, 2015

This research was to develop a guideline to assist physicians to obtain the most helpful imaging workup for pulsatile tinnitus evaluation.

Imaging Evaluation of Pulsatile Tinnitus

Pulsatile Tinnitus Research

Acevedo-Bolton G, Amans MR, Kefayati S, Halbach V, Saloner D. Quant Imaging Med Surg 2015;5(4):635-637. doi: 10.3978/j.issn.2223-4292.2015.04.09 was featured on the cover of the journal. 

Abstract

It has not been previously possible to investigate the link between the presentation of flow related symptoms, such as pulsatile tinnitus, and flow patterns (1). In recent years, magnetic resonance imaging (MRI) has able to determine the full velocity field in 3-dimensional (3D) space through the cardiac cycle. We used MR flow imaging in vivo and in vitro with a patient-specific flow model to study the flow patterns in the dominant right sigmoid sinus and jugular vein of a patient who presented with right-sided subjective pulsatile tinnitus which cannot be heard by an examiner auscultating the head.

Publications

  1. Hasan DM*, Amans M*, Tihan T, Hess C, Guo Y, Cha S, Su H, Martin AJ, Lawton MT, Neuwelt EA, Saloner DA, Young WL. Ferumoxytol-enhanced MRI to Image Inflammation within Human Brain Arteriovenous Malformations: A Pilot Investigation. Transl Stroke Res. 2012 Jul; 3(Suppl 1):166-73. PMID: 23002401. * Shared first authorship

  2. Amans MR. Acute Methotrexate Toxicity: Case of the Week. American Journal of Neuroradiology. Published online 12/10/2012.

  3. Amans MR, Phillips CD. Hepatoblastoma metastatic to brain mimicking intracranial hemorrhage case report and review of the literature. Radiology Case Reports. 7(2) 2012.

  4. Amans MR, Stout C, Fox C, Narvid J, Hetts SW, Cooke DL, Higashida RT, Dowd CF, McSwain H, Halbach VV. Cerebral arteriopathy associated with Arg179His ACTA2 mutation. BMJ Case Rep. 2013; 2013. PMID: 24293535. (BMJ publisher chose to publish article in both J Neurointerv Surg and BMJ Case Rep)

  5. Von Fischer ND*, Amans MR. Dissecting aneurysm of the left PICA: Case of the Week. American Journal of Neuroradiology. Published online 2/2013.

  6. Kansagra AP, Cooke DL, English JD, Sincic RM, Amans MR, Dowd CF, Halbach VV, Higashida RT, Hetts SW. Current trends in endovascular management of traumatic cerebrovascular injury. J Neurointerv Surg. 2014 Jan 1; 6(1):47-50. PMID: 23322749

  7. Amans MR, Stout C, Dowd CF, Higashida RT, Hetts SW, Cooke CL, Narvid J, Halbach VV. . Resolution of pulsatile tinnitus after coil embolization of sigmoid sinus diverticulum. Austin J Cerebrovasc Dis & Stroke. 2014; 2(1):1010.

  8. Chow ML, Cooke DL, Fullerton HJ, Amans MR, Narvid J, Dowd CF, Higashida RT, Halbach VV, Hetts SW. Radiological and clinical features of vein of Galen malformations. J Neurointerv Surg. 2014 Apr 30. PMID: 24789593.

  9. Alexander M, Cooke D, Meyers P, Amans M, Narvid J, Dowd C, Halbach V, Higashida R, Hetts S. O-012 demographic and lesion characteristics outperform degree of stenosis in predicting outcomes following stenting for symptomatic intracranial atherosclerosis. J Neurointerv Surg. 2014 Jul; 6 Suppl 1:A7. PMID: 25064986.

  10. Amans MR, Stout C, Fox C, Narvid J, Hetts SW, Cooke DL, Higashida RT, Dowd CF, McSwain H, Halbach VV. Cerebral arteriopathy associated with Arg179His ACTA2 mutation. J Neurointerv Surg. 2014 Nov; 6(9):e46. PMID: 24353327.

  11. Amans MR, Cooke DL, Vella M, Dowd CF, Halbach VV, Higashida RT, Hetts SW. Contrast Staining on CT after DSA in Ischemic Stroke Patients Progresses to Infarction and Rarely Hemorrhages. Interv Neuroradiol. 2014 Feb; 20(1):106-15. PMID: 24556308. PMCID: PMC3971133

  12. Hetts SW, Cooke DL, Nelson J, Gupta N, Fullerton H, Amans MR, Narvid JA, Moftakhar P, McSwain H, Dowd CF, Higashida RT, Halbach VV, Lawton MT, Kim H. Influence of patient age on angioarchitecture of brain arteriovenous malformations. AJNR Am J Neuroradiol. 2014 Jul; 35(7):1376-80. PMID: 24627452

  13. Hetts SW, Tsai T, Cooke D, Amans M, Narvid J, Dowd C, Higashida R, Halbach V. E-021 de novo, progressive, multiple, and recurrent intracranial dural arteriovenous fistulas: characteristics and outcomes. J Neurointerv Surg. 2014 Jul; 6 Suppl 1:A47. PMID: 25064936.

  14. Amans MR, Narvid J, Halbach VV. Intra-arterial chemotherapy for bilateral retinoblastoma via left ophthalmic artery and right anterior deep temporal artery. BMJ Case Rep. 2014; 2014. PMID: 25240013. PMCID: PMC4170497

  15. Amans MR, Aysenne A, Halbach VV. ICA "T" lesion: Clinical correlation. American Journal of Neuroradiology. Published online 7/2014.

  16. Moftakhar P, Cooke DL, Fullerton HJ, Ko NU, Amans MR, Narvid JA, Dowd CF, Higashida RT, Halbach VV, Hetts SW. Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings. J Neurosurg Pediatr. 2015 Mar; 15(3):282-90. PMID: 25555113.

  17. Hetts SW, Tsai T, Cooke DL, Amans MR, Settecase F, Moftakhar P, Dowd CF, Higashida RT, Lawton MT, Halbach VV. Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes. AJNR Am J Neuroradiol. 2015 Jul 23. PMID: 26206813.

  18. Alexander MD, Rebhun JM, Hetts SW, Kim AS, Nelson J, Kim H, Amans MR, Settecase F, Dowd CF, Halbach VV, Higashida RT, Cooke DL. Lesion location, stability, and pretreatment management: factors affecting outcomes of endovascular treatment for vertebrobasilar atherosclerosis. J Neurointerv Surg. 2015 Mar. PubMed PMID: 25795438. ENG.

  19. Chow ML, Cooke DL, Fullerton HJ, Amans MR, Narvid J, Dowd CF, Higashida RT, Halbach VV, Hetts SW. Vein of Galen Malformations: long-term functional outcome of 6 cases. J Pediatric Neuroradiology (in press).

  20. Narvid J, Amans MR, Cooke DL, Hetts SW, Dillon WP, Higashida RT, Dowd CF, Halbach VV. Spontaneous Retroclival Hematoma: A Case Series. J Neurosurgery (in press).

  21. Acevedo-Bolton G, Amans MR, Kefayati S, Halbach V, Saloner D. Four dimensional magnetic resonance velocimetry for complex flow in the jugular vein. Quant Imaging Med Surg. 2015 Aug; 5(4):635-7. PMID: 26435930. PMCID: PMC4559987.

  22. Amans MR, Meisel K, Glastonbury C. Dural arteriovenous fistula: Clinical correlation. American Journal of Neuroradiology. Published online 12/2015.

  23. Alexander MD, Cooke DL, Meyers PM, Amans MR, Dowd CF, Halbach VV, Higashida RT, Hetts SW. Lesion stability characteristics outperform degree of stenosis in predicting outcomes following stenting for symptomatic intracranial atherosclerosis. J Neurointerv Surg. 2016 Jan; 8(1):19-23. PMID: 25416828.

Multidisciplinary Team

Matthew Amans, MD, Co-Director, Pulsatile Tinnitus ClinicMatthew Amans, MD
Director, Pulsatile Tinnitus Clinic
Associate Professor of Radiology
Neurointerventional Radiology
 

 

Christine Glastonbury, MDChristine Glastonbury, MD
Professor
Vice Chair, Academic Affairs Radiology
Mentorship Director, ENT Radiology

 

 

Wade Smith, MD

Wade Smith, MD
Professor
Neurology

 

 

David Saloner, PhD

Professor
MSBI Program Director


 

 

Charles Limb, MDCharles Limb, MD
Professor, OHNS


 

 

Kazim Narsinh, MD
Assistant Professor of Radiology
Neurointerventional Radiology


 

Allison Lamboy, NP, MSNAllison Lamboy, NP, MSN
Nurse Practitioner