Pulsatile vs Subjective Tinnitus: How to Tell the Difference
Tinnitus is often described as hearing a sound even though there is no outside source producing it. For some people, it may sound like ringing, buzzing, hissing or clicking. For others, it may sound like a rhythmic pulsing that matches their heartbeat.
While all tinnitus involves hearing sounds that are not caused by an external noise, not all tinnitus is the same. Understanding the difference between pulsatile tinnitus and subjective tinnitus can help you better understand your symptoms and determine what type of evaluation may be needed.
In this article, we’ll explain the differences between pulsatile and subjective tinnitus, what causes each type, common symptoms, and when it’s important to seek professional guidance.
Key Takeaways
- Subjective tinnitus is the most common type of tinnitus and is only heard by the person experiencing it.
- Pulsatile tinnitus involves hearing a rhythmic sound that often matches your heartbeat.
- Tinnitus can have many possible causes, including hearing loss, noise exposure, ear conditions, and changes in blood flow.
- A hearing assessment can help identify whether hearing loss or ear-related factors may be contributing to tinnitus.
- Pulsatile tinnitus should be evaluated by a healthcare professional, especially if it is new, persistent, or occurs with other symptoms.
What is Tinnitus?
Tinnitus is the perception of sound when no external sound source is present. It is often described as ringing, buzzing, humming, clicking, or hissing in the ears or head.
Tinnitus is not a condition itself, but rather a symptom that can occur for many different reasons. It may be temporary after loud noise exposure or become a longer-term concern associated with hearing changes, ear health, or other factors. There are several types of tinnitus, but two of the most commonly discussed categories are subjective tinnitus and pulsatile tinnitus.
What is Subjective Tinnitus?
Subjective tinnitus is the most common type of tinnitus. It occurs when a person hears a sound that cannot be detected by anyone else. The sound may occur in one or both ears and can vary from person to person. Some people describe it as:
- Ringing
- Buzzing
- Hissing
- Whistling
- Static
- Clicking
Subjective tinnitus is often related to changes within the auditory system, including the inner ear, auditory nerve, or the way the brain processes sound.
Common Causes of Subjective Tinnitus
Subjective tinnitus can have many possible causes, including:
- Age-related hearing changes
- Exposure to loud noise
- Hearing loss
- Earwax buildup
- Certain medications
- Ear infections or injuries
- Changes in the auditory system
For many people, tinnitus is closely connected with hearing loss. When the brain receives less sound input because of damaged hearing cells, it may generate the perception of sound to compensate for the missing information.
Experiencing Tinnitus? Find Out What May Be Causing It
Tinnitus can have many possible causes, including hearing loss. A hearing assessment can help identify changes in your hearing and determine what support may be appropriate for you.
What is Pulsatile Tinnitus?
Pulsatile tinnitus is a type of tinnitus where the sound has a rhythmic quality and often matches the person’s heartbeat. People commonly describe it as:
- Thumping
- Whooshing
- Pulsing
- Fluttering
- A heartbeat-like sound
Unlike subjective tinnitus, pulsatile tinnitus is often related to changes in blood flow or movement near the ear. Because of this, it is important to discuss new or persistent pulsatile tinnitus with a healthcare professional.
Common Causes of Pulsatile Tinnitus
Possible causes of pulsatile tinnitus may include:
- Changes in blood flow near the ear
- Blood vessel conditions
- High blood pressure
- Ear-related conditions
- Muscle movements near the middle ear
- Other underlying health factors
In some cases, pulsatile tinnitus is caused by an underlying condition that can be identified and treated, which is why an evaluation is recommended.
Pulsatile vs. Subjective Tinnitus: What’s the Difference?
The main difference between pulsatile tinnitus and subjective tinnitus comes down to the type of sound you hear and what may be causing it.
Subjective Tinnitus
Subjective tinnitus is the most common type of tinnitus. It occurs when you hear a sound that is not coming from an external source and cannot be heard by anyone else. The sound can vary from person to person and may be described as:
- Ringing
- Buzzing
- Hissing
- Whistling
- Clicking
- Static
Subjective tinnitus is often related to changes in the auditory system, including hearing loss, noise exposure, or changes in how the brain processes sound.
For many people, tinnitus is associated with hearing loss. When the brain receives less sound information because of damaged inner ear cells, it may create the perception of sound as it attempts to fill in missing information.
Pulsatile Tinnitus
Pulsatile tinnitus is different because the sound has a rhythmic quality and often matches the beat of your heartbeat. People may describe it as:
- Thumping
- Whooshing
- Pulsing
- Fluttering
- Hearing their heartbeat in their ear
Unlike subjective tinnitus, pulsatile tinnitus is often related to changes in blood flow or movement near the ear. Because it can sometimes be associated with underlying medical conditions, it is important to discuss new or persistent pulsatile tinnitus with a healthcare professional.
How They Differ
The easiest way to tell the difference is by paying attention to the sound itself. If your tinnitus sounds like ringing, buzzing, or another continuous noise that does not follow a rhythm, it is more commonly associated with subjective tinnitus. If the sound pulses in time with your heartbeat, it may be pulsatile tinnitus and should be evaluated, especially if it is new, only affects one ear, or is becoming more noticeable.
Not Sure Which Type of Tinnitus You Have?
Understanding the type of tinnitus you’re experiencing can be an important first step. A hearing assessment can help evaluate your hearing and give you a clearer picture of what may be contributing to your symptoms.
Common Causes of Tinnitus
Although tinnitus can feel mysterious, there are several common factors that may contribute to its development.
Hearing Loss
Hearing loss is one of the most common conditions associated with tinnitus. When the auditory system receives less sound information due to changes in the inner ear, the brain may try to compensate for those missing signals by creating the perception of sound. This can result in ringing, buzzing, or other phantom sounds that are only heard by the individual experiencing them.
Noise Exposure
Exposure to loud sounds from workplaces, concerts, firearms, power tools, or recreational activities can damage the delicate sensory cells in the inner ear. These cells play an important role in hearing and do not regenerate once damaged. Over time, this damage can contribute to hearing loss and increase the likelihood of experiencing tinnitus.
Earwax Buildup
A buildup of earwax can block sound from travelling normally through the ear canal, which may contribute to temporary changes in hearing or the perception of sounds like ringing or fullness. In some cases, removing impacted earwax can help reduce tinnitus symptoms when the buildup is contributing to the issue.
Ear Conditions
Certain ear-related conditions can contribute to tinnitus symptoms. Ear infections, changes in the middle ear, injuries, or conditions affecting the inner ear may impact how sound is transmitted and processed. If tinnitus develops alongside ear pain, drainage, dizziness, or sudden changes in hearing, it is important to seek professional advice.
When Should You Seek Help for Tinnitus?
If you experience tinnitus, especially for the first time, it can be helpful to have your hearing evaluated. A hearing assessment can help determine whether hearing loss or other hearing-related factors may be contributing. You should seek medical advice for tinnitus, particularly if:
- The sound is rhythmic and matches your heartbeat
- Tinnitus occurs suddenly
- It only affects one ear
- It is accompanied by dizziness, balance changes, or other symptoms
- It significantly impacts your sleep, concentration, or quality of life
How Hearing Care Professionals Can Help
A hearing care professional can evaluate your hearing and look for factors that may be connected to tinnitus symptoms. During a hearing assessment, they may evaluate:
- Hearing thresholds
- Ear health
- The type and degree of hearing loss
- How tinnitus may relate to your hearing profile
While there is no single solution for every person with tinnitus, understanding your hearing health is an important first step. Depending on your needs, management options may include hearing technology, sound therapy strategies, counselling or recommendations for additional medical evaluation.
Next Steps
Understanding the difference between pulsatile and subjective tinnitus can help you recognize your symptoms and know when to seek support.
If you are experiencing tinnitus, a comprehensive hearing assessment can help determine whether hearing loss or other hearing-related factors may be contributing. Your hearing care professional can answer your questions, evaluate your hearing, and guide you toward the next appropriate steps. If you are concerned about tinnitus symptoms, booking a hearing assessment is a good place to start.
References:
Mayo Clinic (n.d.). Tinnitus. https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156
Biology Insights (26, November 2025). What is Subjective Tinnitus and What Causes It? https://biologyinsights.com/what-is-subjective-tinnitus-and-what-causes-it/
Cleveland Clinic (09, September 2025). Pulsatile Tinnitus. https://my.clevelandclinic.org/health/diseases/23422-pulsatile-tinnitus
VeryWell Health (19, October 2025). What Is Pulsatile Tinnitus? https://www.verywellhealth.com/pulsatile-tinnitus-7111727
Government of Canada (29, May 2024). Noise and sound: Hearing loss and tinnitus. https://www.canada.ca/en/health-canada/services/noise-your-health/hearing-loss-tinnitus.html
