Heartbeat in your ear when lying down: what it can be, how often a cause is found and when to see your GP

This article explains what hearing your heartbeat in your ear when lying down can mean: why you can hear your own pulse in your ear when you lie down, what studies find behind the sound, and when it is a reason to see your GP. That matters, because most people with tinnitus are not much bothered by it,⁠³ while a pulsing sound more often has a cause in the blood vessels that a doctor can look for.⁠² BioProfile’s heart and blood vessel scan gives you an indication of where you stand today with the health of your heart and blood vessels. It is self-insight, to help you make better choices about food and lifestyle. The scan is not a diagnosis. It tells you nothing about the cause of a sound in your ear, and only a doctor can look for that.

What a heartbeat in your ear is

Thuisarts describes pulsatile tinnitus as hearing your blood whooshing in time with your heartbeat, sometimes on one side of the head, and names a narrowed blood vessel, for example in the neck, as a possible cause.⁠³ The Hersen+Zenuw Centrum of Maastricht UMC+ adds that the sound is usually heard in one ear. The sources the centre names are narrowed or widened blood vessels, a blood vessel lying against the hearing nerve, a benign glomus tumour in the ear, or contractions of the tiny muscles of the middle ear.⁠¹ The rhythm you hear is your pulse. What counts as a normal resting heart rate is on our page about a normal heart rate.

Put simply: what you hear is usually blood flowing close to the ear, and there is a short list of known reasons why the ear picks it up.

How common it is

Tinnitus in general is common. A review of studies from around the world found that about 14 in 100 adults have some form of tinnitus and about 2 in 100 have a severe form. Tinnitus becomes more common as you get older, from about 1 in 10 adults under 45 to almost 1 in 4 from 65.⁠⁴ In the Lifelines cohort in the north of the Netherlands, 6.4 per cent of 124,609 adults had constant tinnitus. Constant tinnitus was much more common in people with hearing problems, and slightly more common in people with a heart rhythm disorder or depression.⁠⁵

The pulsing form is a small part of that. In the Netherlands, 1 to 1.5 million people have tinnitus, and fewer than 1 in 100 of them hear the pulsing form.⁠¹ So hearing your heartbeat is unusual, and that is one reason to look into it more closely.

Heartbeat in your ear when lying down: why it is louder

At a specialist clinic in San Francisco, 164 people with pulsatile tinnitus were examined in detail. For about 4 in 10 of them, the sound got worse when lying down. A different body position made the sound worse for two in three, and better for about 4 in 10.⁠² A German review article explains a useful difference: a sound caused by a vein often gets quieter or stops when the vein in the neck on that side is pressed or the head is turned towards the sound, while a sound from an artery does not respond to this.⁠⁶

What this means for you: a sound that changes with the way you lie down is common in this group, and the way it changes gives a doctor a first clue about which blood vessel is involved.

What doctors find behind it

Among the clinic’s 164 patients, the source was in a vein in almost half, in an abnormal short circuit between an artery and a vein in about 1 in 5, in an artery in fewer than 1 in 10, and outside the blood vessels in about 1 in 4. Of the cases in a vein, about three quarters had their source in a narrowed large vein in the brain, including a condition called idiopathic intracranial hypertension: raised pressure inside the skull with no known cause.⁠² Bear in mind that this was a specialised group, selected for detailed imaging of the blood vessels.

In a German group of 77 patients, doctors found a cause in almost 9 in 10 when the sound was in one ear, and in about 4 in 10 when it was in both ears. The most common findings were tumours of the bone around the ear with a rich blood supply, variations in the veins, and narrowed blood vessels.⁠⁶

Raised pressure inside the skull shows how the sound can go together with other signs. In a North American study of 165 people with this condition, about half heard a pulsing sound in the ear, the majority had headaches, and about two in three had brief moments of reduced vision.⁠⁷ Put simply: a pulsing sound in one ear, or a sound that comes with headaches or changes in your sight, is the kind of sound you want to have checked.

How a doctor looks for the cause

A review of 17 studies with 1,232 patients compared different scans. A CT scan of the blood vessels found a cause most often, in about 86 in 100 patients. An MRI found one in just over half, and an ultrasound of the carotid arteries in about 1 in 5. The authors conclude that choosing the scan based on the signs a person has works better than examining everyone the same way.⁠⁸ Maastricht UMC+ notes that an MRI can help find a cause in the blood vessels, but does not always give a clear answer.⁠¹

What this means: the first step is a GP who listens to your story and examines you, because your story decides which tests make sense.

When to see your GP

Thuisarts names clear warning signs. Call your GP straight away if the tinnitus starts suddenly and you suddenly hear less in one ear. Make an appointment if the sound starts suddenly, for example after an accident or a blow to the head, if it is in one ear, or if ear pain, headache, dizziness or problems with your sight come with it.⁠³

What the heart scan measures and what it does not

The BioProfile heart scan gives you a picture of where you stand today with the health of your heart and blood vessels, as a baseline that can be measured again later. It is self-insight. The scan does not hear any sound, does not find any blood vessel and says nothing about the cause of a pulsing in your ear. The scan is not a diagnosis. Your daily habits count towards that picture of your heart and blood vessels. You can read what sitting still does to your body in the effects of moving too little, and which heart complaints women report in heart complaints in women.

In summary

Hearing your heartbeat in your ear is the rare, pulsing form of tinnitus. The sound often changes when you lie down or turn your head, and in specialist studies the source was usually in the blood vessels, often in a vein. When the sound is in one ear, a cause is often found, more often than when it is in both ears. A sudden start, pulsing on one side, or headache, dizziness, ear pain or worse eyesight alongside it are reasons to see your GP. The heart scan gives you self-insight into your heart and blood vessels. Finding the cause of the sound is a job for a doctor.