DEAR DR. GOTT: First of all, I have been checked out by an ear, nose and throat doctor who says everything is okay. I’ve had a normal ultrasound on my carotid arteries and a CT of my aorta. My problem is that I have a pulsation in my right ear. I can hear my heart beat all the time with a “whooshing” sound with each beat. During the day it doesn’t bother me but when I’m trying to go to sleep, it’s awful. I’ve tried ear plugs, listening to white noise and elevating my pillows to no avail. It is interfering with my sleep! I don’t want to resort to sleeping pills but I’m afraid I’m going to have to. What could be causing this? It’s only gotten bad over the past six months. I didn’t notice it before.
I have two full-time jobs. I’m 61 and a grandmother of five. I love life, but there’s not enough time in each day! I’m 5’5” tall, about 160 pounds, not diabetic, but I do take blood pressure and cholesterol meds. I’m at a loss! Please give me your thoughts.
DEAR READER: There are several causes for your symptoms, including infection, vascular abnormalities, fluid buildup, and more. Infection in the middle ear causes swelling that, in turn, increases blood flow to the area and results in pulsations. If water or other fluids collect behind the ear drum, infection can easily set in. A thyroid abnormality can increase the flow of blood through the jugular vein that passes near the auditory nerve. This too can cause a pulsation that can be treated rather easily with medication. Tinnitus, caused by damage to the hair cells of the inner ear can cause a whooshing sound in one or both ears, as can wax impaction. The impaction may be accompanied by pain. Ear wax is normal and healthy because it traps water and prevents foreign particles from penetrating the ear and causing infection. If you have a tendency to clean your ears regularly, you could be pushing wax deeper into the ear canal with each attempt and intensifying an already difficult situation. That’s why it has always been my belief a person shouldn’t put anything smaller than an elbow into the ear.
Carotid artery disease (CAD) occurs when a substance known as plaque builds up inside the carotid arteries. Over time, that plaque hardens, blocking the arteries, or can break off from the arterial wall and travel through the bloodstream, causing major problems. Risk of developing CAD increase if a person has high cholesterol levels, hypertension, is a smoker, fails to exercise sufficiently, or because of a family history. Making dietary and lifestyle changes that may include prescription medication can reduce the risk tremendously.
You’ve already seen a specialist who couldn‘t find anything wrong and had a negative ultrasound and CT. My best guess is that you have tinnitus, although I don’t understand why your ENT specialist didn’t offer this a possibility. You can always request a referral for another opinion. Be sure to take your X-ray reports with you. Another pair of eyes reviewing your reports might bring something to light that can ultimately provide relief. You may need imaging of your head. This may involve an MRA (a variant of the MRI that also involves the arteries). There are vascular disorders that can be to blame that may be due to plaque buildup. There are also arterial bruits caused by turbulent blood flow. You may benefit from a large medical center.
In the interim, take whatever steps you can to reduce your stress levels, ask your primary care physician if the blood pressure and cholesterol meds you are taking have even the slightest connection with your ears, exercise regularly, and eat well.
Readers who would like related information can order my Health Report “Ear Infections and Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.