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Pounding in ear with rise in heart rate. Recommended MRI scan. What do you advise?

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ENT Specialist
Practicing since : 1991
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Two weeks again I starting noticing a pounding in my left ear when I my heart rate speeds up (exercising, walking up the stairs quickly, carrying something heavy). It has become stronger and more pronounced. Sometimes I feel it in bed at night but mostly it is not detectable when my heart is at a resting rate. I talked to my doctor about it yesterday at my physical and he said it could be the blood vessels in my head could have moved around a bit (I recently lost 6 pounds -- FYI I am 5'2" female, 53 years old, small frame, 106 pounds, have low blood pressure, a waking up heart rate in 40's or 50's and resting heart rate in 50's and 60's, am not on any medication, I walk/run 45 minutes a day -- I have been eating an XXXXXXX Induction diet in order to loose some belly fat, hence the 6 pound weight loss). I wish my doctor had taken my symptoms more seriously. He didn't even listen around my ear to see if he could detect anything unusual. He said I could get an MRI if I wanted to. I don't want to take unnecessary tests but I also don't want to ignore something that may indicate a deeper problem.
Posted Fri, 26 Apr 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query.

1. This is probably a case of vascular tinnitus. Exercise and activity causes dilatation of blood vessels, increasing the blood flow and hence you can hear the increased blood flow synchronous with your heart beat. Get your blood pressure checked at different times. Get a cardiac check-up.

2. The question now arises as to why this is happening only in the left ear since the last two weeks. Do get your ears checked to rule out ear wax and ear drum problems.

2. Atherosclerosis causing turbulent blood flow in the carotid arteries is only one of many causes of tinnitus. Cervical spondylosis usually affects the basilar arteries which travel through the cervical spine. Get a Neck Vessel Doppler study done. If the sounds wake you in the morning, get cervical spine x-rays done and use a different pillow height and type to see whether the tinnitus changes / subsides.

3. If the sound can be heard by others, it is known as objective tinnitus. the bruit may be heard by inserting the tube of the stethoscope gently into the ear canal or with the bell of the stethoscope cupped onto the ear and mastoid bone.. There is no cure for tinnitus however in certain cases, it can be controlled.

4. Decreased hearing also makes one more aware of tinnitus. By the age of 53, you may have normal age induced hearing loss (Presbyacusis). Get a PTA (Pure Tone Audiogram) done. If you have a hearing loss, amplification may help mask the tinnitus.

5. You may also get middle ear pressure checked (Impedance Audiometry). This is because loss of fat, for example around the Eustachian tube may cause a fluid build-up in the middle ear, due to which you may be hearing the sounds.

6. There is no option besides an MRI and MR Angiogram to locate an offending blood vessel pressing against the Vestibulocochlear (Eighth Cranial) Nerve. However, people with normal MRI Scans have also required micro vascular decompression.

7. If you cannot ignore this tinnitus, you may start with these investigations. Medication is unlikely to be of use here.

8. You may share the reports here for further treatment options.

Hope, I have answered your query. Please accept my answer in case you do not have further queries.

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