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Experiencing tinnitus, headaches and shooting pains across face. Diagnosed with high BP and spat blood clots

May 2014
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Practicing since : 2002
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Hi, I've been experiencing a kind of pulsating tinnitus in my left ear and concurrent headaches and pain in temples,shooting pains across my face and flushing intermittently for about 2 months, following some problems with my left ear.
I've also been diagnosed with high blood sugar by my GP.Yesterday I also spat out some black blood clots in the morning, which i think came from my nasal passages or back of throat- not chest;(no symptoms, and not recurred.)
The main problem is this constant pulsing/humming in my left ear and shooting pains in head and sometimes across face.
I've also been referred to an ENT out patient clinic in 4 week's time.I'm worried there may also some vascular problem.
Many thanks, J.
Posted Sat, 6 Jul 2013 in Ear, Nose and Throat Problems
Answered by Dr. Vivek Chail 2 hours later
Thanks for writing in.

Though your long medical history has been noted, I will concentrate on your pulsatile tinnitus.

You have reported having this problem for two months now with cocurrent headsches.
Pulsatile tinnitus cannot be localized to single cause in most cases. Still we must consider all relevant causes and reach a specific one.

Investigation is primarily through imaging but before that let’s talk on what can cause it.
1. Generalized increased blood flow: conditions like anaemia and thyroid hyperfunctional states.
2. Localized increased blood flow: persistent stapedial artery in middle ear, any benign growth
3. Turbulent blood flow: atherosclerosis in walls of arteries.
4. Increased sensitivity in ear: conductive hearing loss due to infection.
5. Benign intracranial hypertension.

What you should do next?
Please consult an ear, nose, throat surgeon, give complete details of your medical problem, and include older details.
Your doctor needs to check you with an otoscope, study your tympanic membrane (eardrum), and look for signs of disease and perforation.
Then they may do hearing tests for you.

Subsequently a complete blood test (to look in detail for anaemia as you have mentioned it in your past) and thyroid function tests will be called for.

Your doctor may ask for following radiological investigations:
1. Doppler of carotid and vertebral arteries.
2. CT scan of brain.
3. HRCT scan of mastoids and temporal bone.
4. MRI with MR angiography of ear and brain.

All these investigations are office procedures.
I just hope we find a soecific cause for your problem and it gets treated at the earliest.

Further questions welcome.
If you don't have any more questions, I request you to please close this thread and post a feedback.

Dr Vivek
Above answer was peer-reviewed by
Follow-up: Experiencing tinnitus, headaches and shooting pains across face. Diagnosed with high BP and spat blood clots 2 hours later
Hi Dr Chail,

Thankyou very much for this information, which I've found very useful and relevant.

I'm rather cautious about posting my personal medical details online,
and hope that this will also remain confidential via the main site please?

I'd also like to retain these details for future reference.

Could I ask if the ENT doctor is able or likely to refer me on to
a vascular specialist, should this be viewed as a possible underlying
cause, or multiple problems that need to be investigated?
For example, CT or MRI scan/angiography if warranted.
If it is pulsatile tinnitus, the picture sounds very complicated-
and possibly no one investigation.

My main concern at present is the nature of the headaches,
which spreads across my temples, sometimes feels as if behind
eyes, across my face, neck and back of my head.The humming sound
in my left ear always goes with it; also my face looks very flushed
and red- which is unusual for me.I've never suffered with ear problems
or headaches before.

I'll wait to see the ENT specialist also, but hope it's nothing more serious
that requires a sooner assessment.If my symptoms worsen I will seek
advice as an urgent appointment with GP; although in my experience
they don't seem to have specialist knowledge or the time to deal
with health problems that may be more complicated; it's also
a long wait for outpatient appointments.

I don't know how urgently I should be treating these symptoms- or whether to just ignore as much as possible.

Are there any symptoms I should seek advice for more urgently in relation
to the headaches?

Hopefully I'll be able to wait until my ENT appointment in 4 weeks;
but I'm a bit sceptical whether I shall be fully assessed- eg possibility of vascular

Thankyou again, and would appreciate a possible response on the subject of the headaches and facial pain in conjunction with tinnitus.

I'm a bit worried about the possibility of things like arteritis, or even worse case scenario- aneurism, strokes etc.

Hopefully there will be a simpler explanation.

Kind regards, Jo F.

Answered by Dr. Vivek Chail 10 hours later

Thanks for writing in.

Let me assure you the highest level of doctor – patient privacy.

I have mentioned a round up of investigations that you may require and please remember, you need not undergo each and every test.

I learn that your main concern is the tinnitus along with headache, pains in your temples, face, retro orbital region (behind eyes) and neck, and I guess that all problems are on the left side.

These regions have one thing in common; they are supplied by branches of cranial nerve V (five) which is named as trigeminal nerve. I was just wondering if I can connect your tinnitus with trigeminal neuralgia, a condition of the said nerve which causes facial pains. This can be due to the proximity of both nerves (nerve supplying the face and ear) inside the head. There is an area known as jugular bulb area which can hold the key to your problems. Please note that this is just a possibility and need not hold good in all patients.

You could request your ENT doctor to refer you to a neurologist. I suppose the neurologist will carefully examine you and suggest investigations from his perspective. Correlating with neurological examination findings, your MRI can always confirm or rule out any intracranial cause. If any vascular findings are noted which are to be dealt with a specialist, then probably an appointment with a vascular surgeon will be required. A Doppler examination of your carotid and vertebral arteries can be suggested by either doctor, this is a safe non invasive procedure.

I see that you are really worried about if it is arteritis, aneurysm or strokes and I think you have searched for information yourself. Most of the rare cases are shared online and you need not worry about any life threatening conditions even before meeting your doctors. I fully agree with your apprehensions but let’s hope that nothing’s serious and proceed in the right direction, praying that you get back to your healthy life soon.

Finally, you want to know if and when to consider your problem serious. If you are experiencing severe headaches, vomiting, nausea and any blackout; I guess your must be investigated as an emergency. Even otherwise, you can request an early appointment from your ENT surgeon in 2 – 4 weeks time.

I have tried my best to make our discussion simple.
Wishing you good health.

Further questions welcome.
If you don't have any more questions, I request you to please close this thread and post a feedback.

Dr Vivek
Above answer was peer-reviewed by
Follow-up: Experiencing tinnitus, headaches and shooting pains across face. Diagnosed with high BP and spat blood clots 12 hours later

Thankyou so much again for your helpful and comprehensive advice;
I realise these are possibilities, and unless symptoms worsen will
try to deal with.My partner also belongs to a private health care scheme,
which we have not used before; so if things worsen I may seek
sooner help than waiting another 4 weeks.

It sounds like a complex picture to assess, but hopefully
the cause can be found sooner rather than later.

Thankyou for assuring full confidentiality, and I will definitely recommend
this site to others, should the need arise to seek expert advice.

I wish you well also, and thankyou very much again.

Kind regards, Jo F.

PS I will close this thread once comment has been submitted,
but also hope to keep this information for my own reference-
thanks again, J.
Answered by Dr. Vivek Chail 3 hours later
Thanks for writing in.
Welcome for your positive feedback.
Just hoping that I have answered most of the questions you had in your mind at the start of this discussion.

I pray to the Lord that let there be nothing serious causing your problems and that you make a quick recovery back to your normal life.

I do recommend that you utilise any private health care scheme if situation demands.

I hope this information for your future reference. Thanks in anticipation for choosing to close this thread and posting a feedback.

Thanks for your wishes.

Wishing you a healthy and long life.

Dr Vivek
Above answer was peer-reviewed by
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