Q. I have a pulsatile tinnitus in my inner ear for the last six weeks. Please help.

Answered by
Dr. Krishna Swaroop Achanta
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 24, 2021 and last reviewed on: Jun 22, 2021

Hi doctor,

Can TMJ disorder cause pulsatile tinnitus? I have had pulsatile tinnitus for six weeks. I also have a TMJ disorder. It hurts intermittently inside my ear and sometimes on the sides of my face. But my concern is about the 24/7 pulsatile tinnitus. I have had every test. MRI without contrast of the head and neck, MRA of the neck with contrast, MRV of the head with contrast (they inadvertently did not do MRA of the head with contrast). I also had CT angiography of the head and neck with contrast and ultrasound of my neck. I am so upset. They can find nothing wrong. Instead, I have an ocean noise combined with my pulse in the inner ear. I did order a mouthguard from the dentist. Any thoughts on the above tests or what you may advise?



Welcome to The oceanic noise which you feel you are hearing in your inner ear may have nothing to do with your TMJ (temporomandibular joint) disorder. TMJ disorders usually produce clicking, grating or popping sounds along with tinnitus that increases in intensity over time or aggravate the ear condition but if you feel that it is worsening continuosly it would signify an inner ear infection (like an infection of the ear canal that requires evaluation and treatment by the ENT specialist). It is highly recommended that you wear your mouth guard regularly especially in the nights or whenever you are at rest and not talking or chewing.

The Probable causes:

Vestibular disturbance in the ear meaning temporary degenerative changes in the inner ear, temporomandibular joint infection, or disorders. Systemic links like Klippel-Trenuanay and Maffucci syndrome.

Investigations to be done:

ENT (ear, nose, throat) specialist checkup. Please visit the otolaryngologist as soon as possible in person. In clinic consultation with your previous reports and medical records is advised, along with a report of your complete blood count (CBC) and blood pressure readings.

Probable diagnosis:

Ear canal or vestibular disturbance.
Temporary degenerative changes in the ear causing tinnitus.

Treatment plan:

For a complete solution, please visit your otolaryngologist in person in their clinic. A few home remedy tips to help reduce tinnitus,
1. Avoid coffee (caffeine). Substitute with fresh milk or tea.
2. Nicotine should be strictly discontinued if you have a smoking habit in any form.
3. Avoid or limit alcoholic beverages.
4. Your ENT specialist, after examination of the inner ear, may recommend hearing aids if the tinnitus progressively worsens. So please find out if it is necessary to use it to prevent hearing loss.
5. Multivitamin therapy is needed as recommended by the general physician. Brands will vary, but Vitamin B12 capsules or Multivitamin combination every day after food along with Vitamin C supplements will greatly help.
6. Eat fiber-rich foods, and more protein intake is needed.
7. Do not listen to any loud music or avoid noise to the internal ear canal for a period of two to three months till the tinnitus subsides.
8. Meditation, yoga poises to promote blood flow to the inner ear, and head region will improve oxygen saturation and help reduce tinnitus.
9. Sleeping for a minimum of eight to nine hours in the night will relieve your stress.
10. Avoid neck exercises or quick rotational movements strictly, as it can aggravate your tinnitus. Lastly, please visit your general physician in person or otolaryngologist to check the inner ear.

Hi doctor,

Thanks for the reply.

I did have vertigo before the pulse tinnitus began. I was doing neck exercises for vertigo. Then pulse tinnitus came. Also, before this started, I was diagnosed with Demodex and rosacea, probably because I have an autoimmune disease and take immunosuppressants. They told me to put a cream of Ivermectin on my skin twice a day for a few weeks. Now my mind is getting out of control. Do you think the Demodex mites could have gone in my ears and causing this? I have no symptoms of it except pulse tinnitus. Thank you.



Welcome back to

Though it is considered rare that human mites can potentially harm your ear canal, it may be possible for them to thrive in the inner ear. Once your otolaryngologist looks in your inner ear, they can place a medicament or give you a suitable prescription or ear drops to treat the infection. Do follow all the advice listed in the points previously, and you will find your tinnitus bearable and reduced to an extent. Good sleep, multivitamin therapy, and proper oral hygiene, along with steam inhalation every day, will help. As you rightly said, immunosuppressants can lower your body's immune response, but as your doctor necessarily suggests them, you will need to continue it as usual. Vertigo as well exaggerates the symptoms sometimes, so do visit the ENT specialist for specific medications. I hope this helped.


Investigations to be done:

1. Blood test- Complete blood count.
2. Ear canal examination.

Preventive measures:

1. Consult an ENT specialist.
2. TMJ relaxation by a mouthguard.
3. Steam inhalation.
4. Meditation, yoga, and adequate sleep.
5. Multivitamin therapy and fibrous or protein-rich food.
6. Do not clean your ears with cotton buds. Instead, make sure it is clean with your fingers, and wash your hands later.
7. Avoid nicotine, caffeine, and alcohol.

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