1. Heartbeat In Head After Gamma Knife Making
2. Heartbeat In Ear
3. Heartbeat In Head
4. Hearing Your Heartbeat In Your Head

Timothy C. Hain, MD. •Page last modified: October 11, 2020

What you have may be “pulsatile tinnitus”; a rhythmic thumping or whooshing that only you can hear, often in time with your heartbeat. A 49-year-old man presented to the Emergency Department (ED) with a chief complaint of 'there is a heartbeat in my eye.' Pertinent history included an episode of trauma 2 months prior to his onset of unilateral vision loss. Computed tomography scan of the head obtained in the ED upon his initial inj.

In pulsatile tinnitus, people hear something resembling their heartbeat in their ear.

• Pulsatile tinnitus is usually due to a small blood vessel that is coupled by fluid to your ear drum. It is usually nothing serious and also untreatable.
• Rarely pulsatile tinnitus can be caused by more serious problems -- aneurysms, increased pressure in the head (hydrocephalus), and hardening of the arteries. A vascular tumor such as a 'glomus' may fill the middle ear, or a vein similar to a varicose vein may make enough noise to be heard.
• Inner ear disorders that increase hearing sensitivity (such as SCD) can cause pulsatile tinnitus. As this condition can be corrected surgically, it is one of the few 'fixable' causes of pulsatile tinnitus. In the few patients we have encountered, the sound was not a 'swishing' sound.
• There are some very large blood vessels -- the carotid artery and the jugular vein -- that are very close to the inner ear (see diagram above). Noise in those blood vessels can be conducted into the inner ear. Accordingly, other possibilities for vascular tinnitus include dehiscence (missing bone) of the jugular bulb -- an area in the skull which contains the jugular vein, and an aberrantly located carotid artery. An enlarged jugular bulb on the involved side is common in persons with venous type pulsatile tinnitus.
• Anything that increases blood flow or turbulence such as hyperthyroidism, low blood viscosity (e.g. anemia), or tortuous blood vessels may cause pulsatile tinnitus.

Testing for pulsatile tinnitus:

It is common for persons with pulsatile tinnitus to have some sort of procedure done in the Radiology department, looking for something that can be fixed. Usually these show nothing. Rarely they find something important. Even when 'something is found', usually there is nothing to do other than say -- maybe this is causing your tinnitus.

According to Branstetter and Weissman (who are radiologists, and of course emphasize Xray or MRI evaluation), entities that can cause unilateral pulsatile tinnitus include:

• Aberrant internal artery (congenital)
• Dehiscent internal carotid artery
• Aberrant anterior inferior cerebellar artery (that loops into the ICA)
• Aberrant sigmoid sinus (displaced anteromedially from its normal course)
• Stenosed dural sinus (Best seen on MRV or CT-venography)
• Persistent stapedial artery (isolated aberrant vessel in the inner ear, seen on CT). The ipsilateral foramen spinosum is absent in these patients.

Other entities than the ones listed above that can sometimes be seen on radiological testing and that can cause pulsatile tinnitus, include AVM's, aneurysms, carotid artery dissection, fibromuscular dysplasia, venous hums from the jugular vein (found in half the normal population), vascular tumors such as glomus, ossifying hemangiomas of the facial nerve, osseous dysplasias such as otosclerosis and Paget's, and elevated intracranial pressure.

Practically, MRI/MRA or CT is often suggested in younger patients with unilateral pulsatile tinnitus. In older patients, pulsatile tinnitus is often due to atherosclerotic disease and it is less important to get an MRI/MRA. A lumbar puncture may be considered if there is a possibility of benign intracranial hypertension. More invasive testing includes the 'balloon occlusion test', where a balloon is blown up in the internal jugular vein to see if it eliminates tinnitus. These are very rarely done.

If tinnitus goes away with compression of the Jugular vein in the neck, it is usually not going to help to get any kind of radiology procedure. On the other hand, if somebody else can hear tinnitus (with a stethoscope on the skull), that is a good reason to get a vascular procedure. In 2018, MRI/MRA is generally the best choice, as it has high resolution and has no radiation. The purpose of the MRI is to look for intracranial hypertension. In our opinion, a 'Time resolved MRA', is usually the second step after an MRA is done and is abnormal. Selective catheter angiograms are unreasonably dangerous. CT angiograms, done with venous contrast, combine high radiation with low yield.

Internal Carotid problems

Aberrant internal carotid artery.

This is a congenital anomaly in which the internal carotid can present as a middle ear mass. If the carotid fails to develop correctly during fetal life, the inferior tympanic artery enlarges to take it's place. It enters the skull through it's own foramen, courses through the medial part of the middle ear, and then rejoins the petrous ICA (Branstetter and Weissman, 2006).

Dehiscent internal carotid.

The ICA may not have a bony covering as it courses through the middle ear.

Stenosed internal carotid

A bruit from a narrowed IC may cause tinnitus.

Aberrant AICA.

Some authors claim that branches of the AICA may abut the 8th nerve and cause tinnitus. We find this idea dubious as the 8th nerve has no hearing receptors.

Tinnitus due to AV fistula -- dural AV fistulae (DAVF).

This lengthy discussion was moved the a separate page (davf)

Heartbeat In Head After Gamma Knife Making

Tinnitus due to high jugular bulb and related structures

This subject is discussed on a separate page.

Pulsatile tinnitus can also be associated with benign intracranial hypertension (BIH), also known as pseudotumor cerebri. Pseudotumor cerebri is discussed here.

Heartbeat In Ear

Sigmoid sinus diverticulum/dehiscence is another cause of venous tinnitus. Sun and Sun (2019) discuss reconstuction of the sigmoid sinus wall. As of 2020, we have never encountered this procedure in our clinical context in Chicago Illinois.

References:

• Branstetter BF, Weissman JL. The radiologic evaluation of tinnitus. Eur Radiol (2006) 2792-2802
• Sun J, Sun J. Sandwich technique for sigmoid sinus wall reconstruction for treatment of pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence. Acta Otolaryngol. 2019 Sep 27:1-4. doi: 10.1080/00016489.2019.1668960.
• Yazawa et al, 2009. Surgical observations on the endolymphatic sac in Meniere's disease. Am J. Otol 19:71-75, 1998

Heartbeat in the Brain is a 1970 documentary film produced and directed by Amanda Feilding, an advocate of trepanation.^[1] In the film, Feilding, a 27-year-old student at the time, drills a hole in her forehead with a dentist's drill. In the documentary, surgical scenes alternate with motion studies of Feilding's pet pigeon Birdie.^[2]

In 1978, Feilding screened the movie at the Suydam Gallery in New York. More than one audience member fainted during the climax.^[1]

Heartbeat In Head

The 1998 documentary A Hole in the Head contains footage from Heartbeat in the Brain.^[3]

The documentary, long believed to be lost, was publicly screened at the Institute of Contemporary Arts, London on 28 April 2011.^[4]

References[edit]

1. ^ ^abTurner, Christopher (Winter 2007–08). 'Like a Hole in the Head'. Cabinet. Retrieved 8 December 2012.CS1 maint: discouraged parameter (link)
2. ^Colton, Michael (31 May 1998). 'You Need It Like... ...a Hole in the Head?'. The Washington Post.
3. ^Sirius, R. U. (25 August 2010). 'Fixing A Hole in the Head'. h+.
4. ^'PR Talks Films Music Ourhouse 02 Feb 2011'. Official Website Institute of Contemporary Arts. ICA. Archived from the original on 27 November 2011. Retrieved 4 March 2012.CS1 maint: discouraged parameter (link)

Hearing Your Heartbeat In Your Head