Pulsatile Tinnitus – The heartbeat in your ear

An ENT's Operating Otoscope
A whooshing, pulsating, or swooshing sound in the ear is called pulsatile tinnitus and usually just affects one side.  Often this may sound like a heartbeat in your ear – and often you are in fact hearing your heartbeat or turbulent blood flow through the vessels that passed through your skull near your ear.  These blood vessels are right next to the hearing sensor apparatus so its pretty easy to start hearing your own blood flow sometimes.
Sometimes pulsatile tinnitus refers to a clicking or popping in that you are that happen spontaneously.  This is a completely different concern related to nerve or muscle spasms in the ear.  In this case it will feel like clicking popping or snapping in your ear, again usually just one side.
Pulsatile tinnitus that persists and sounds like a heartbeat usually deserves further workup.  Problems with blood vessels, such as blood clots, aneurysm, or dissection may be found.  Sometimes there may be thinning of the membranes surrounding the cochlea and inner ear and you could be hearing the pulsations from your brain!.  Rarely tumors may also present with a pulsatile tinnitus, including glomus tumors or tumors next to the brain impacting the hearing nerves.  Most of these are non cancerous but can be serious conditions because of where they are located.
Workup for pulsatile tinnitus includes a good clinical evaluation of the ear physically, in addition to hearing function, speech discrimination, bone conduction and tympanometry.  Angiography, CT, or MRI imaging may be recommended depending what we find to try to sort out the cause.