FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER SHOULD SEE EAR-NOSE-THROAT SPECIALIST ABOUT EAR NOISE

Question: I have had a drumming noise in my left ear that sounds like my heartbeat. This has been going on for about one year, and it is about to drive me crazy. The noise stops when I push on the artery on the left side of my neck, and it speeds up when my heart speeds up. My aunt, who is a nurse, said that it could be a blood clot or something like that in my head. My primary care doctor doesn't have a clue and also doesn't seem concerned about it. I'm frustrated and concerned. Do you have any ideas about the cause and cure for my drumming noise?

Answer: As you probably know, the ear mechanisms amplify sounds from around us and, thereby, drown out the sounds we make -- principally the sounds of our breathing and our heartbeat. The "drumming" sound you experience, since it changes its cadence with your heart rate and goes away when you press on the artery on the left side of your neck, is undoubtedly caused by your own heartbeat. In one sense, I guess it is good to know that your heart is still working. On the other hand, I understand how annoying the persistent "drumming" must be. By the way, the artery that you've been pressing on is called the left common carotid artery; there is a similar artery -- the right common carotid -- on the right side of your neck.

All of us hear our heartbeat when we engage in vigorous physical exertion. Actually, I only notice mine when I've stopped exercising and am cooling down. That's when my vigorous heartbeat is transmitted along the carotid arteries, which carry the "lub-dub" sound of my healthy heart on to my ears. Your persistent "drumming" could be due to nothing more serious than this phenomena. However, I doubt that your cause is this simple for two reasons: first, it has only been going on for the past year; and second, you also notice it when you are at rest.

The medical term for a noise that you hear that does not have an external source is "tinnitus" and the word for beating or throbbing (or drumming) is "pulsatile." The sound you describe is, therefore, correctly called a pulsatile tinnitus. It can have many different causes.

The middle ear space can become filled with fluid, usually as a consequence of chronic middle ear infection. This fluid can transmit the sound of the heartbeat into the inner ear and, thereby, cause pulsatile tinnitus. In this situation, there is also a noticeable decrease in hearing in the affected ear. Since you didn't report hearing trouble, I think that it is unlikely that this is the cause of your symptoms.

A glomus tumor, which forms a connection between small arteries and veins, can develop in the middle ear. This type of growth pulses with the heartbeat, and consequently could cause your symptoms. An unnatural swelling -- called an aneurysm -- in one of the arteries of the brain or even one in the carotid arteries could produce your symptoms. Even a partial blockage of the left carotid artery could be the culprit. All of these causes are serious and deserve further evaluation.

I disagree with your primary care doctor. I think your pulsatile tinnitus is important and potentially the sign of a life-threatening yet correctable problem. I think you should see an Ear-Nose-Throat (ENT) specialist for an adequate evaluation of your symptoms. I also disagree with your aunt. I don't think a blood clot is at fault.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.