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Author: admin, 26.11.2014
The state-of-the-art German-technology Haux pressure chambers which we are employing for Hyperbaric Oxygen Therapy, are available for patients ranging from 1 day old newborn babies to conscious and unconscious patients, producing successful outcomes. The British Tinnitus Association (BTA) is a world leader, with a trained team of friendly and experienced advisers for anyone who experiences tinnitus or those simply seeking guidance or information about the condition. This information has been written to help you understand more about the type of tinnitus known as pulsatile tinnitus, which is tinnitus which appears to follow a rhythm such as your heart beat. By contrast, pulsatile tinnitus is a rhythmical noise that usually has the same rate as the heart. When doctors investigate cases of tinnitus, it is rare for them to find a single identifiable cause for the problem.
Pulsatile tinnitus is due to a change in blood flow in the vessels near the ear or to a change in awareness of that blood flow. Sometimes blood flow is increased in a single blood vessel or group of blood vessels rather than a generalised increase. If the inside of a blood vessel becomes irregular due to atherosclerosis (hardening of the arteries), the blood flow will become turbulent rather than smooth. Conductive hearing loss such as a perforated ear drum or glue ear tend to make people more aware of sounds inside their body because they no longer have the masking effect of external sounds. Heightened sensitivity in the auditory pathways can alert the brain to normal noise in blood vessels in much the same way that the awareness of non-pulsatile tinnitus is generated. It is important to state that this is not an exhaustive list of the causes of pulsatile tinnitus and that anyone with this symptom should seek assessment by an appropriate doctor.
The doctor will start by taking a detailed history of the tinnitus and will ask about any other medical conditions that you may have. A stethoscope may be used to listen to the neck and skull–if the doctor can hear a pulsatile noise through the stethoscope this is referred to as objective pulsatile tinnitus. This produces pictures of the head and inner ears using magnetic fields rather than X-rays. MRA can be used to produce images of the inside of arteries or veins and can show up irregularities or narrowing of the vessel. By giving an injection of a substance that shows up on X-rays (contrast medium) and then performing a CT scan it is possible to obtain images of the inside of blood vessels. This is a way of looking at the inside of vessels by injecting contrast medium into the vessel under investigation and taking a conventional X-ray. Some causes are less amenable to treatment: if the pulsatile tinnitus is due to a specific blood vessel, these may not be treatable, depending on location. For those people with pulsatile tinnitus who have no demonstrable abnormality, there are a variety of methods to manage the tinnitus which people find helpful. There are a few examples of tinnitus where a rhythmical sound is experienced but the sound is not synchronised with the person’s heart beat.

More rarely, this type of rhythmical tinnitus can be caused by contraction of some of the muscles of the soft palate at the back of the throat. Many people with this type of tinnitus are able to tolerate it easily once they understand that there is no serious cause. There is another rare type of tinnitus called Patulous Eustachian Tube Syndrome in which people experience a form of tinnitus that varies with their breathing.
A list of the references used in preparing and reviewing this leaflet is available on request. Our helpline staff can answer your questions on this and other tinnitus related topics on 0800 018 0527. This information has been produced by the BTA and conforms to the Principles and Requirements of the Information Standard. The sound may be a ringing, whistling, or rushing sound, or it may be more complex like machinery or the twittering of birds. With pulsatile tinnitus, the chances of finding a specific cause are more likely than in the non-pulsatile form, but it is still difficult to identify a definite cause. The involved vessels include the large arteries and veins in the neck and base of the skull and smaller ones in the ear itself. For example, during foetal development we all have an artery in our middle ear called the stapedial artery.
This flow then becomes noisy in the same way that a smoothly running river will become noisier at a set of rapids or waterfall.
In particular, there is a condition called benign or idiopathic intracranial hypertension, which is characterised by headaches and visual disturbance as well as pulsatile tinnitus.
The doctor will then examine you, paying particular attention to the ear drums and the blood vessels of the neck. Pulsatile tinnitus that cannot be heard by the doctor is called subjective pulsatile tinnitus. Modern ultrasound scanning uses a technique called Doppler, which can show the blood flow within the blood vessels in the neck.
It still produces clearer, more detailed pictures of vessels than any of the other techniques and therefore is still used in selected cases.
For example, a full blood count (FBC) may be required to rule out anaemia or thyroid function tests (TFTs) may be requested if an overactive thyroid gland is suspected.
For example, anaemia can be treated with medication or blood transfusion, glue ear can be treated with grommets, perforations can be closed with grafts and narrowed segments of artery can be repaired. These include techniques such as sound therapy, relaxation therapy, Cognitive Behavioural Therapy (CBT), counselling, mindfulness meditation, or Tinnitus Retraining Therapy (TRT). This type of tinnitus is most commonly due to rhythmical contraction of the muscles in the middle ear.

Occasionally these muscles can go into rhythmical contraction – in much the same way that the muscles at the corner of the eye can twitch when we get tired. People with these forms of tinnitus should consult their doctor as there is a small chance that an underlying cause can be detected. If not, it is possible to perform a surgical procedure to cut the muscles in the middle ear or to inject botulinum toxin into the palatal muscles.
They may also feel that their ear seems blocked and their voice seems to echo inside their head. Although the sound may not be present all the time, when it is noticeable it tends to be a steady noise with no frequent or regular changes in its loudness. There are a few types of tinnitus in which a rhythmical sound is experienced that is not in time with the pulse - this is discussed at the end of this leaflet. It can also occur in severe anaemia or when the thyroid gland is overactive, a condition known as hyperthyroidism or thyrotoxicosis. This normally closes before birth but it can occasionally persist and in this case blood flow adjacent to middle ear structures can generate pulsatile tinnitus. People with any form of tinnitus will have a series of hearing tests and pulsatile tinnitus is no different in this respect. If benign intracranial hypertension is suspected, the doctor may ask for opinions from other doctors such as ophthalmologists or neurologists who may request their own specialised investigations. This condition is actually due to excessive openness of the Eustachian tube – the tube that runs from the back of the nose to the inside of the ear. Tumours of the head and neck cause the development of abnormal blood vessels and this can result in pulsatile tinnitus. If it becomes abnormally open the pressure changes caused by our breathing is transmitted via the tube to the inside of the ear. Many people with this condition report that it started after a period of sudden weight loss. Various treatments have been tried including injecting material around the tube or cauterising the opening of the tube to reduce its patency (degree of openness). Again, there are a number of techniques which can be helpful in managing this tinnitus sound therapy, relaxation therapy, CBT, counselling, mindfulness meditation, or TRT.

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