Pulsatile tinnitus Q&A w/ Mayo Clinic expert, Dr. Breen July 16

Thank You for taking our questions, Dr. Breen
I am 65 and have always "had a little ringing" in my ears. It is best described as the sound you hear after listening to something too loud. The past couple of months it has gotten louder progressively to the point I can hear it over other sounds. I have not had a hearing test. Should I be concerned that it is getting louder or is it age related? Do I start with and ENT or audiologist?

I lost my vestibular system along with sudden loss of hearing in my right ear in November’24. Would Betahistamine be helpful for my constant state of wooziness?
Is there anything one can do to alleviate tinnitus?

Dr Breen,
I have tried to manage a patulous eustation disorder for 20 years now. It is impossible for me to socialise as it is so debilitating. Is there any successful alternative to surgery?
Also I have intermittent pulsatile tinnitus.
Many thanks.
Caryl

Having a hx of tinnitus many years ago which spontaneously cleared, I recently experienced a reoccurrence that seems to coincide with unsteadiness. Are they related and is their anything I can do to clear?

Dr. Been,
Idk if you're addressing regular tinnitus but I've had it for years. I've heard it can be caused by nerves in the brain? I can't hear as well because of that rushing sound in my ears. Is there an answer for tinnitus?

Hello! Particularly if the pulsing sound is just in one ear, a CT scan without contrast can still be helpful. The bone structure around the inner ear and the nearby blood vessels can be evaluated without contrast, and sometimes this gives useful information. MRI scans are also useful in many cases, and the contrast agents are different - it would be unusual for somebody to be allergic to MRI contrast (gadolinium), and an allergy to CT contrast (iodinated) is not a contraindication to giving gadolinium.

If it's not clear what is going on from just looking at your ear, an ENT might be able to learn more from CT or MRI scans. When it's NOT in sync with your heartbeat, it's less common that we find explanations on the scans, however. One cause to investigate might be spasms of the middle ear muscles - two small muscles that attach to your hearing bones. These can cause "quivering" or "fluttering" type sounds that come and go randomly, not in sync with your heartbeat. This often goes away on its own, but sometimes medications or surgeries have been used to manage it.

I'm sorry to hear you've had such a difficult time with this symptom despite all these efforts. It's hard to comment on your specific situation without being able to look at your images. If the PT is heard to be exactly in sync with your heartbeat, it probably has something to do with blood flow. You can check your pulse and feel/hear if it is synchronized. Also, if it's just in one ear, it's more likely to be vascular. When it's in both ears... it's often less clear. Sometimes ENT doctors can find and treat causes that are not as well managed by neurointerventional procedures, so I would encourage you to meet an ENT doctor in your area with some expertise in ear surgery. Some example diagnoses include sigmoid sinus wall abnormalities or superior semicircular canal dehiscence. You've had lots of the testing - sometimes having a fresh set of eyes to look at everything can be helpful!

Thanks for the "like" Dr. Breen. Do you recommend I contact you at Mayo?
I live in Vero Beach, central FL, East Coast

Thank you. I'm scheduled to see my ENT Dr again on Aug. 7. My PT is in both ears and exactly in sync with my heartbeat. I really appreciate your response. I may contact you again after I meet with my ENT. Thank you again!