Why Do I Hear My Heartbeat in My Ear? Medical Reasons You Should Know

Article At a Glance

• Hearing a rhythmic sound that follows your heartbeat is commonly called pulsatile tinnitus.
• Pulsatile tinnitus differs from typical ringing or buzzing tinnitus because blood flow, vascular structures, middle-ear conditions, or other physical processes may contribute.
• Many possible causes are treatable, but the symptom should not be diagnosed from its sound alone.
• New or persistent pulse-synchronous tinnitus deserves medical evaluation, particularly when it occurs on one side or is accompanied by hearing, balance, vision, headache, or neurological symptoms.
• Sudden neurological symptoms, severe acute headache, or other emergency warning signs require urgent medical care.

Hearing your heartbeat in your ear can be unsettling.

People often describe the sound as:

• Whooshing
• Thumping
• Pulsing
• Beating
• Rushing

When the sound consistently follows the rhythm of your heartbeat, it is commonly called pulsatile tinnitus.

Unlike the more familiar ringing, buzzing, or hissing forms of tinnitus, pulsatile tinnitus can sometimes be associated with an identifiable physical sound source or changes involving blood flow.

That does not mean every case is dangerous.

It does mean that persistent pulse-synchronous tinnitus deserves appropriate evaluation rather than being automatically treated as ordinary tinnitus.

What Is Pulsatile Tinnitus?

Pulsatile tinnitus is the perception of a rhythmic sound that often corresponds with the heartbeat.

It can occur:

• In one ear
• In both ears
• Intermittently
• Persistently
• Only in certain positions
• During particular activities

Some people notice it mainly in quiet environments or while lying in bed.

Others hear it throughout the day.

The intensity can also vary.

The defining feature is not simply that the sound is rhythmic. The important question is whether it is pulse-synchronous — meaning its timing follows the heartbeat.

Why Can You Hear Your Heartbeat in Your Ear?

Major arteries and veins are located relatively close to the structures involved in hearing.

Under some circumstances, blood-flow sounds or other internally generated sounds can become audible.

Possible mechanisms include:

• Changes in the speed or pattern of blood flow
• Changes in blood vessels near the ear
• Increased blood flow through the body
• Structural differences that transmit internal sound more efficiently
• Middle-ear conditions that make internal sounds easier to hear
• Increased awareness of normal internal sounds

The symptom cannot reliably tell you which mechanism is responsible.

That is why medical history, examination, hearing testing, and sometimes imaging are used to investigate persistent pulsatile tinnitus.

Is Pulsatile Tinnitus Different From Regular Tinnitus?

Yes.

Typical subjective tinnitus is often described as:

• Ringing
• Buzzing
• Hissing
• Whistling
• Humming

It usually does not follow the heartbeat.

Pulsatile tinnitus has a rhythmic quality and may sometimes be associated with an actual physical source.

Historically, tinnitus has also been classified as subjective or objective.

Objective tinnitus refers to uncommon situations in which an internal physical sound may potentially be detectable by an examiner.

Not all pulsatile tinnitus is objectively audible, however.

For clinical purposes, describing whether tinnitus is pulse-synchronous, unilateral or bilateral, intermittent or persistent, and associated with other symptoms can be more useful.

What Can Cause Pulsatile Tinnitus?

Pulsatile tinnitus has a broad range of possible causes.

Some involve blood flow.

Others involve the ear, surrounding structures, or systemic medical conditions.

Possible contributors include:

• Changes in arterial or venous blood flow
• Selected vascular abnormalities
• High-output circulatory states
• Middle-ear conditions
• Structural abnormalities involving the temporal bone or nearby anatomy
• Selected tumors involving highly vascular tissues
• Intracranial pressure disorders
• Other medical or anatomical conditions

This list is not a diagnosis.

The same symptom can occur for very different reasons.

Can Exercise Make You Hear Your Heartbeat?

Some people temporarily become more aware of their heartbeat during or immediately after strenuous physical activity.

Exercise increases heart rate and cardiac output.

This can make internal pulsations easier to notice, especially in a quiet environment.

A brief pulse sound that appears only during strenuous exertion and disappears as the cardiovascular system returns toward baseline may have a different significance from new persistent pulsatile tinnitus.

However, exercise should not automatically be assumed to explain a recurring symptom.

Discuss the symptom with a healthcare professional when it:

• Is new and repeatedly occurs
• Persists after exercise
• Occurs with relatively mild exertion
• Is consistently present on one side
• Occurs with dizziness, headache, vision changes, chest symptoms, or other concerning symptoms

Can Stress Make Pulsatile Tinnitus More Noticeable?

Stress can increase heart rate and influence blood pressure.

It can also increase attention to internal sensations.

For those reasons, some people become more aware of pulse-synchronous sound during stressful periods.

Stress does not prove that the symptom is caused by anxiety.

A new or persistent pulse-synchronous sound should not be dismissed as stress without appropriate evaluation.

Relaxation strategies may help reduce distress, but they are not substitutes for investigating persistent pulsatile tinnitus.

Can Ear Problems Make Your Pulse More Audible?

Yes.

Conditions that change how sound travels through the outer or middle ear can sometimes make internally generated sounds more noticeable.

Possible examples include:

• Middle-ear fluid
• Some ear infections
• Conductive hearing loss
• Selected Eustachian tube disorders
• Other middle-ear abnormalities

A clinician can examine the ear and determine whether an ear condition may be contributing.

Do not assume that congestion or an ear infection is the cause simply because those symptoms occur at the same time.

Can High Blood Pressure Cause Pulsatile Tinnitus?

Blood pressure can influence blood flow and may contribute to pulse-synchronous sound in some situations.

However, pulsatile tinnitus should not automatically be attributed to hypertension.

Many other vascular and nonvascular conditions can produce similar symptoms.

If you have concerns about your blood pressure, have it measured appropriately and discuss the results with your healthcare professional.

Treatment of hypertension should be based on your cardiovascular health rather than undertaken solely as a tinnitus treatment.

Atherosclerosis and Arterial Disease

Atherosclerosis involves plaque accumulation within arteries.

Changes in arterial structure can affect blood-flow patterns.

When vessels near the head and neck are involved, vascular sound can sometimes become more noticeable.

Pulsatile tinnitus does not establish carotid artery disease.

Likewise, hearing the sound more strongly on one side does not identify which blood vessel is involved.

A clinician determines whether vascular evaluation is appropriate based on the overall presentation, examination, risk factors, and other findings.

Can Anemia Contribute?

Anemia can create a higher-output circulatory state as the body compensates for reduced oxygen-carrying capacity.

In selected cases, this can contribute to awareness of vascular sound.

Anemia has many possible causes and should not be diagnosed from pulsatile tinnitus alone.

Blood testing may be appropriate when medical history or other symptoms suggest anemia or another systemic condition.

Treating a confirmed underlying condition may improve associated pulsatile tinnitus, but improvement should not be guaranteed.

Can Thyroid Conditions Be Involved?

Some thyroid disorders can alter heart rate and cardiovascular activity.

Hyperthyroidism, for example, can produce a higher-output circulatory state.

A clinician may consider thyroid testing when symptoms and medical history suggest it is appropriate.

Routine thyroid testing is not necessarily required for every person with pulsatile tinnitus.

Pregnancy and Pulsatile Tinnitus

Pregnancy produces substantial cardiovascular and hormonal changes.

Blood volume and cardiac output increase, and some pregnant people become more aware of vascular sounds.

Pulsatile tinnitus during pregnancy should not automatically be considered harmless.

New pulse-synchronous tinnitus should be discussed with the healthcare professional providing prenatal care, particularly when accompanied by:

• Elevated blood pressure
• Severe or persistent headache
• Vision changes
• Significant swelling
• Shortness of breath
• Other concerning symptoms

These symptoms can have many explanations, but pregnancy is not a reason to ignore them.

What Is Idiopathic Intracranial Hypertension?

Idiopathic intracranial hypertension, often abbreviated IIH, is a disorder involving elevated pressure around the brain without an identified mass lesion or other obvious cause explaining the pressure increase.

Pulsatile tinnitus can occur with IIH.

Other possible symptoms include:

• Headache
• Temporary visual disturbances
• Double vision
• Blind spots or other vision changes

Because elevated intracranial pressure can threaten vision in some cases, pulse-synchronous tinnitus accompanied by significant headache or visual symptoms deserves medical evaluation.

Pulsatile tinnitus alone does not mean that IIH is present.

Can Blood Vessel Abnormalities Cause Pulsatile Tinnitus?

Yes.

Selected abnormalities involving arteries or veins can produce pulse-synchronous sound.

Examples that clinicians may consider include:

• Arteriovenous fistulas
• Arteriovenous malformations
• Venous sinus abnormalities
• Arterial narrowing
• Selected aneurysms
• Other vascular conditions

These conditions differ substantially in frequency, severity, and treatment.

The presence of pulsatile tinnitus does not establish any one of them.

Imaging is used selectively when the clinical presentation suggests a vascular source should be investigated.

Can a Tumor Cause Pulsatile Tinnitus?

Certain uncommon tumors involving vascular structures of the middle ear or skull base can cause pulsatile tinnitus.

These are not the explanation for most people who hear their heartbeat.

A clinician may become more suspicious of a structural lesion when pulsatile tinnitus occurs with findings such as:

• A visible abnormality behind the eardrum
• Persistent unilateral symptoms
• Conductive hearing loss
• Neurological findings
• Other abnormalities on examination

Imaging can be used when clinically indicated.

What About Superior Semicircular Canal Dehiscence?

Superior semicircular canal dehiscence is a structural condition involving an abnormal opening or thinning in the bone overlying part of the inner ear.

Possible symptoms can include:

• Unusual sensitivity to internal body sounds
• Sound- or pressure-induced dizziness
• Autophony, or unusually loud perception of one’s own voice
• Conductive-appearing hearing findings
• Sometimes pulsatile tinnitus

Diagnosis requires appropriate clinical evaluation and specialized testing.

Pulsatile tinnitus alone does not establish this condition.

Why One-Sided Pulsatile Tinnitus Matters

Pulsatile tinnitus can occur on one side or both.

Persistent unilateral symptoms can sometimes increase concern for a localized vascular, middle-ear, or structural source.

That does not mean bilateral pulsatile tinnitus is automatically harmless.

Both unilateral and bilateral persistent pulse-synchronous tinnitus can warrant evaluation.

One-sided symptoms are simply an important detail for the clinician to know.

How Is Pulsatile Tinnitus Evaluated?

Evaluation usually begins with a detailed history.

A healthcare professional may ask:

• When did the sound begin?
• Is it in one ear or both?
• Does it exactly follow your heartbeat?
• Is it constant or intermittent?
• Does position affect it?
• Does exercise change it?
• Have you noticed hearing loss?
• Do you have dizziness or balance problems?
• Do you have headaches or visual symptoms?
• Have you experienced recent ear disease or injury?
• What medications are you taking?
• Do you have cardiovascular or neurological conditions?

The answers help determine what testing may be appropriate.

Physical Examination

Depending on the clinical setting, examination may include:

• Inspection of the ear canals and eardrums
• Blood-pressure measurement
• Head and neck examination
• Listening for vascular sounds when appropriate
• Neurological examination when indicated

Some internally generated vascular sounds may occasionally be audible to an examiner.

Many cases of pulsatile tinnitus are not externally audible.

Hearing Testing

An audiological evaluation can help identify:

• Sensorineural hearing loss
• Conductive hearing loss
• Differences between the ears
• Middle-ear abnormalities
• Other findings relevant to the evaluation

Testing may include pure-tone audiometry, speech testing, and tympanometry or other middle-ear measures when appropriate.

Learn more about hearing health and hearing evaluation.

Are Blood Tests Needed?

Sometimes.

Blood tests are not automatically required for every person with pulsatile tinnitus.

They may be ordered when medical history or examination suggests conditions such as:

• Anemia
• Thyroid disease
• Other systemic disorders

Testing should be guided by the clinical situation rather than a fixed tinnitus checklist.

When Is Imaging Used?

Imaging is commonly considered when clinicians need to investigate possible vascular or structural causes.

Depending on the suspected cause, imaging can include:

• MRI
• MR angiography or venography
• CT
• CT angiography or venography
• Other specialized vascular studies

No single imaging study is appropriate for every case.

The choice depends on symptoms, examination findings, hearing-test results, medical history, and the suspected source.

How Is Pulsatile Tinnitus Treated?

Treatment depends entirely on the underlying cause.

There is no universal pulsatile tinnitus medication.

Possible management can involve:

• Treating an identified ear condition
• Managing a confirmed systemic medical disorder
• Treating an appropriate vascular condition
• Monitoring selected findings
• Surgical or endovascular treatment for appropriately selected structural or vascular abnormalities
• Symptom-management strategies when no reversible cause is identified

The correct treatment cannot be selected simply from the sound of the tinnitus.

Are Medications Used?

Medication may be used when an identified medical condition requires it.

For example, a person with diagnosed hypertension, anemia, thyroid disease, infection, or another medical disorder may receive treatment appropriate to that condition.

There is no standard list of blood-pressure drugs, anticoagulants, steroids, antihistamines, or other medications that should be taken specifically because pulsatile tinnitus is present.

Some of those drugs can be inappropriate or dangerous when used without a valid medical indication.

Do not start, stop, or change medication in an attempt to treat pulsatile tinnitus without guidance from the healthcare professional managing your care.

When Are Procedures or Surgery Used?

Selected vascular or structural causes can sometimes be treated with procedures.

Depending on the diagnosis, specialists may consider:

• Endovascular treatment
• Vascular procedures
• Middle-ear surgery
• Skull-base surgery
• Procedures addressing selected venous abnormalities
• Other condition-specific interventions

The risks, benefits, and expected outcomes vary substantially according to the diagnosis and procedure.

There is no meaningful universal success rate that applies to all surgeries for pulsatile tinnitus.

Can Pulsatile Tinnitus Go Away?

Yes, in some cases.

When pulsatile tinnitus is associated with a temporary condition or a treatable underlying cause, it may improve or resolve.

Other cases can persist.

The outcome depends on the cause.

A persistent symptom should not automatically be interpreted as permanent, and treatment should not be promised to eliminate the sound.

Managing Pulsatile Tinnitus While It Is Being Evaluated

Persistent pulsatile tinnitus can be distracting, particularly in quiet environments.

Symptom-management strategies may help while the underlying cause is being investigated.

Use Comfortable Background Sound

Some people find that neutral environmental sound makes the pulse less prominent.

Possible options include:

• A fan
• Quiet nature sounds
• Low-level music
• Broadband sound
• Other comfortable environmental sounds

The goal does not need to be complete masking.

Keep sound at a comfortable level.

Support Healthy Sleep

Tinnitus often becomes more noticeable at bedtime because the environment is quiet.

A consistent sleep schedule and comfortable background sound can help some people.

Persistent insomnia deserves its own evaluation and treatment rather than being assumed to be an unavoidable part of tinnitus.

Manage Stress

Relaxation, mindfulness, counseling, or other stress-management strategies can reduce distress associated with tinnitus.

They do not diagnose or correct a vascular cause.

Use them as coping strategies rather than substitutes for medical evaluation.

Follow Medical Guidance for Existing Conditions

If you already have hypertension, cardiovascular disease, anemia, thyroid disease, or another diagnosed condition, follow the treatment plan established with your healthcare professional.

Do not independently change medications, sodium intake, exercise, or other medical management solely because pulsatile tinnitus has appeared.

Should You Reduce Caffeine, Alcohol, or Salt?

There is no universal pulsatile tinnitus diet.

Caffeine, alcohol, and sodium can affect cardiovascular physiology in different ways, but that does not justify telling everyone with pulsatile tinnitus to eliminate them.

People with hypertension, Ménière’s disease, kidney disease, heart disease, or other medical conditions may have dietary recommendations for those conditions.

Follow individualized medical advice rather than generic tinnitus restrictions.

If you notice a reproducible relationship between a substance and your symptoms, mention it during your evaluation.

Should You Exercise?

Regular physical activity has broad health benefits for many people.

Pulsatile tinnitus alone is not a reason to prescribe or prohibit a particular exercise program.

If you have cardiovascular disease, significant hypertension, neurological symptoms, pregnancy-related concerns, or other medical conditions, follow exercise guidance appropriate to your health.

If exertion consistently triggers substantial pulsatile tinnitus or other symptoms, discuss the pattern with a healthcare professional.

When Should You See a Healthcare Professional?

New or persistent pulse-synchronous tinnitus deserves medical attention.

Evaluation is especially important when it is:

• Persistent
• Clearly synchronized with the heartbeat
• Present mainly or entirely on one side
• Associated with hearing changes
• Associated with significant dizziness or balance difficulty
• Accompanied by headaches or vision changes
• Associated with other neurological symptoms
• New during pregnancy
• Developing after head or neck injury

There is no need to wait for an arbitrary number of days or weeks before discussing a new persistent pulse-synchronous symptom.

When Is Emergency Care Appropriate?

Pulsatile tinnitus by itself is not automatically an emergency.

Seek emergency medical care when it occurs with symptoms suggesting an acute neurological or cardiovascular problem, such as:

• Sudden weakness or numbness
• Facial drooping
• Difficulty speaking or understanding language
• Sudden severe vision changes
• Severe difficulty walking
• Loss of consciousness
• A sudden severe or unusual headache
• Severe chest symptoms
• Other sudden serious neurological symptoms

A sudden unexplained hearing loss also deserves prompt medical evaluation.

Frequently Asked Questions

Is It Normal to Hear Your Heartbeat in Your Ear?

Brief awareness of your pulse can occur in some circumstances, such as immediately after strenuous activity or when lying quietly with an ear against a pillow.

Persistent pulse-synchronous tinnitus is different.

If you repeatedly or persistently hear a sound that follows your heartbeat, discuss it with a healthcare professional.

Is Pulsatile Tinnitus Dangerous?

Not necessarily.

Pulsatile tinnitus has many possible causes, including some that are relatively benign and others that require treatment.

The symptom alone cannot determine the cause.

Appropriate evaluation is important because potentially treatable vascular, structural, ear-related, or systemic conditions can sometimes be identified.

Is One-Sided Pulsatile Tinnitus More Concerning?

Persistent unilateral pulsatile tinnitus can increase concern for a localized source and is an important reason for evaluation.

Bilateral pulsatile tinnitus should not automatically be considered harmless.

The complete symptom pattern matters.

Can High Blood Pressure Cause a Whooshing Sound in the Ear?

Blood-pressure changes can influence vascular sound in some people, but a whooshing sound should not automatically be diagnosed as hypertension.

Blood pressure can be measured directly, and persistent pulsatile tinnitus may require investigation for other causes.

Can Anxiety Cause Pulsatile Tinnitus?

Anxiety can increase heart rate and attention to internal sensations, making pulse sounds more noticeable.

It should not automatically be assumed to explain new persistent pulse-synchronous tinnitus.

Can an Ear Infection Cause Pulsatile Tinnitus?

Ear infection, middle-ear fluid, or other conductive ear conditions can sometimes increase awareness of internal sounds.

Persistent pulsatile tinnitus should still be evaluated rather than automatically attributed to an infection.

Can Pregnancy Cause Pulsatile Tinnitus?

Cardiovascular changes during pregnancy can contribute to awareness of pulse-synchronous sound.

New pulsatile tinnitus during pregnancy should be discussed with the clinician providing prenatal care, particularly when accompanied by headache, high blood pressure, visual symptoms, or other concerning changes.

Will Pulsatile Tinnitus Go Away on Its Own?

It depends on the cause.

Some temporary cases improve as the contributing condition resolves.

Others persist until an underlying condition is identified or treated, and some may remain even after evaluation.

There is no universal timeline.

Does Pulsatile Tinnitus Always Require Imaging?

No.

Imaging decisions depend on the history, examination, hearing-test findings, whether the tinnitus is unilateral or bilateral, and other symptoms.

When a vascular or structural cause needs investigation, imaging can be an important part of the evaluation.

Can Sound Therapy Treat Pulsatile Tinnitus?

Background sound may make pulsatile tinnitus less noticeable and can help some people cope with the symptom.

It does not treat a vascular, structural, or systemic underlying cause.

Persistent pulse-synchronous tinnitus should therefore be evaluated even if masking sound makes it easier to tolerate.

Who Should I See for Pulsatile Tinnitus?

A primary-care clinician or otolaryngologist can begin medical evaluation.

An audiologist can evaluate hearing and middle-ear function.

Depending on the findings, additional specialists such as neurologists, neurotologists, radiologists, vascular specialists, or other clinicians may become involved.

The appropriate pathway depends on the suspected cause.

The Bottom Line

Hearing a whooshing, thumping, or pulsing sound that follows your heartbeat is commonly called pulsatile tinnitus.

It differs from typical ringing tinnitus because blood flow, vascular structures, middle-ear conditions, systemic medical disorders, or other physical processes can sometimes contribute.

Many causes are manageable or treatable.

The important first step is identifying what is actually causing the symptom.

Do not assume persistent pulsatile tinnitus is simply anxiety, high blood pressure, congestion, exercise, or ordinary tinnitus.

Likewise, hearing your heartbeat does not automatically mean that you have a dangerous vascular disorder.

New or persistent pulse-synchronous tinnitus deserves appropriate medical evaluation, particularly when it is one-sided or accompanied by hearing changes, headaches, vision problems, balance symptoms, or neurological findings.

If serious acute neurological symptoms occur, seek emergency medical care.