Hearing your heartbeat whooshing or thumping over and over in one ear can be disconcerting. While this constant noise may be annoying, it can also raise concerns — could it be linked to pulmonary hypertension (PH)?

Is It OK To Hear Your Heartbeat in Your Ear?

The phenomenon of hearing your heartbeat in your ear is generally referred to as pulsatile tinnitus. Although it can be unsettling, pulsatile tinnitus is not directly caused by pulmonary hypertension. While occasionally hearing your heartbeat in your ear is usually not a cause for concern, persistent pulsatile tinnitus should be evaluated by a healthcare professional. This symptom may indicate various underlying health conditions, some of which might require treatment. It could be related to vascular conditions affecting the heart, veins, or arteries, but nonvascular causes or abnormalities may also be involved.

Hearing your heartbeat constantly can be frustrating, distracting, and even anxiety-provoking, potentially affecting your mental health. Understanding the cause of this symptom is key to managing its impact on your daily life.

If you’ve ever asked yourself, “Why can I hear my heartbeat in my ear when I lie down?” or “Why do I experience pulsatile tinnitus in one ear only?”continue reading to learn about potential causes and management options.

What Pulsatile Tinnitus Feels Like

Pulsatile tinnitus is a rare form of tinnitus in which you hear a whooshing, thumping, or throbbing sound, usually to the sound that typically aligns with your heartbeat. You may notice it in one or both ears, and it can either come and go or be constant.

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 pulsatile tinnitus that wakes me up at night. It sounds like someone in the room is breathing loudly, but it’s in my ears.”

Some people also can experience pulsatile tinnitus that changes with head position.

The sound in your ear may change in volume or pitch and usually matches the frequency of your heartbeat, speeding up with activities like walking up stairs and slowing down afterward.

Some people have also asked, “Is it normal to hear your heartbeat in your ear on a pillow?” While it’s not uncommon to occasionally hear your heartbeat when lying down, persistent pulsatile tinnitus, even when resting, should be discussed with a health care provider.

Why Is Pulsatile Tinnitus a Red Flag?

Pulsatile tinnitus itself is not a condition but rather a symptom of other conditions. It can be a red flag because it may indicate an underlying vascular condition (a condition affecting the blood vessels, heart, or circulation) or neurological condition (affecting the brain, nerves, or nervous system). Although it isn’t always linked to something serious, it’s important to have it evaluated by a health care provider to rule out any dangerous causes.

If you hear your heartbeat in your ears, consult your health care provider to determine the cause. Treating the underlying issue is key to finding relief from pulsatile tinnitus. Below are some potential conditions that may be responsible.

1. Venous Sinus Stenosis

Research suggests that venous sinus stenosis is the most common cause of pulsatile tinnitus, both of which mostly affect women, according to the journal Stroke: Vascular and Interventional Neurology. Venous sinus stenosis occurs when blood flow is blocked in the venous sinuses — channels that drain blood from the head. Since these sinuses run near the ear, narrowed or obstructed blood flow may result in pulsatile tinnitus.

Where Do You Press To Stop or Relieve Pulsatile Tinnitus?

In some cases of venous sinus stenosis, gently pressing on the largest vein on the affected side of the neck may temporarily reduce or stop the sound of pulsatile tinnitus. However, this is only a temporary fix and may not work for those with persistent symptoms. Always consult your health care provider before trying any neck-compression techniques.

For people whose quality of life is significantly impacted by venous sinus stenosis and pulsatile tinnitus, a more lasting solution may be venous sinus stenting. This minimally invasive procedure involves placing a small tube in the narrowed venous sinuses to relieve pressure and improve blood flow.

2. Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension (IIH) occurs when there is a buildup of cerebrospinal fluid (the fluid surrounding the brain and spinal cord), which increases intracranial pressure (pressure inside the skull around the brain). This elevated pressure can cause pulsatile tinnitus, as well as headaches and vision problems. One potential cause of IIH is venous sinus stenosis, which impairs blood drainage from the brain and raises intracranial pressure.

Idiopathic intracranial hypertension is rare, affecting about 1 in 100,000 people in general. However, it is more common among young females with obesity (20 in 100,000), according to Cleveland Clinic. Obesity is diagnosed in people with a body mass index (BMI) — a ratio of a person’s weight to height — of 30 or higher.

Treatment for IIH may include weight loss, medication, or surgery in severe cases, as recommended by a health care provider.

3. High Blood Pressure

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

Managing hypertension often involves lifestyle changes, such as engaging in regular exercise, achieving a healthy weight, 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 that hardens the arteries. When plaque accumulates in the blood vessels supplying the heart, it can lead to coronary artery disease, which is the most common cause of heart failure. Heart failure, in turn, is the leading cause of secondary pulmonary hypertension — a type of PH that arises due to heart problems. PH is not the same as primary pulmonary arterial hypertension (PAH). Treatment for PH caused by heart failure focuses on managing the heart failure itself, not using medications designed for primary PH.

Narrowed arteries due to atherosclerosis can affect blood flow throughout the body, including the head, neck, or ears, producing a whooshing or pulsating sound. A health care provider may detect this sound in the carotid arteries using a stethoscope.

Managing atherosclerosis typically involves lifestyle changes, such as getting regular physical activity, following a healthy diet, and avoiding cigarette smoke by quitting smoking or steering clear of secondhand smoke. A health care provider may also prescribe 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. These blood vessel tangles, called arteriovenous malformations, can alter blood flow in the area, resulting in a pulsating sound in the ears. Arteriovenous malformations are very rare, affecting just 1 in 100,000 people, according to Cleveland Clinic.

Treatment for blood vessel malformations varies depending on the type. In some cases, they may need to be surgically removed to redirect blood flow to normal 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. Similarly, thin or missing bones near the major veins and arteries that run by the ear may also cause you to hear your heartbeat.

Semicircular canal dehiscence syndrome may be treated with surgery to plug the canal, which can reduce fluid movement in the inner ear, thereby helping to alleviate 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.
• They can be very vascular, meaning they have a lot of blood flow.

Although these tumors grow slowly, they can press on blood vessels in the neck and head, altering blood flow and causing you to hear your heartbeat.

Since glomus tumors are benign (noncancerous), they may not always require treatment. However, if the tumor causes balance or hearing problems, such as constant pulsatile tinnitus, a health care provider may recommend removing the tumor.

Other Causes

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

• Anemia — A blood disorder characterized by a lack of healthy red blood cells
• Head trauma
• Paget’s disease — A chronic bone disease that may affect the skull
• Hyperthyroidism — An overactive thyroid, the gland in the neck that regulates metabolism

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

Medications and Pulsatile Tinnitus

When managing pulsatile tinnitus alongside pulmonary hypertension treatment, it’s important to know which medications may be used with caution and which should be avoided — particularly when using nitric oxide as part of your PH therapy.

Always consult your health care provider before starting or stopping any medication. Your doctor will help create a treatment plan that addresses your pulsatile tinnitus while considering your overall health needs. Remember, what works for others may not be the best option for you.

Use With Caution

• Beta-blockers — These medications are used for a variety of conditions, including pulsatile tinnitus. Certain beta-blockers may be safe for use with nitric oxide, and they may even enhance treatment effects.
• Blood thinners — Anticoagulants that prevent blood clots may be used to treat both PH and pulsatile tinnitus. However, some people may develop tinnitus with regular use of blood thinners like acetylsalicylic acid (aspirin).
• Antibiotics — Certain antibiotics, like aminoglycosides, may damage the inner ear and worsen tinnitus. If you’re prone to tinnitus, be sure to discuss antibiotic alternatives with your doctor.
• Diuretics — Diuretics (water pills) can help reduce fluid buildup, and some may be beneficial in treating pulsatile tinnitus. However, they should be used with caution as they could worsen symptoms or lead to hearing loss over time.
• Natural therapies — Complementary therapies such as certain supplements, acupuncture, or sound therapy might help relieve pulsatile tinnitus symptoms. Always consult your doctor before trying any natural remedies to ensure they’re safe for you.

Try To Avoid

• Caffeine — Limit large amounts of caffeine or other types of stimulants, as they can increase blood pressure and potentially worsen pulsatile tinnitus symptoms.
• Ototoxic medications — Some medications are ototoxic, meaning they can damage the inner ear and worsen tinnitus. While these medications may be necessary for other health reasons, it's important to discuss potential side effects with your doctor.

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 55,000 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.