Is it normal to hear my heartbeat in my ear when I lie down at night?

Often, yes. Pressing an ear against a pillow blocks outside sound, so the normal noise of blood flow near the ear becomes easier to hear. If it stops when you change position, it is usually harmless. If it happens in every position or only in one ear, mention it to a doctor.

Can anxiety or stress make me hear my pulse in my ear?

Stress can speed up and strengthen your heartbeat, which can make the sound more noticeable for a while. It is also easier to notice a sound when you are focused on it. Anxiety should not be assumed as the cause of a persistent one-sided whoosh until a doctor has examined you.

Which doctor should I see for a pulsing sound in my ear?

A primary care doctor can check your ears, blood pressure, and blood tests first. An ear, nose, and throat specialist usually leads the workup. You may also be referred to a neuro-ophthalmologist, a neurologist, or an interventional neuroradiologist depending on what the tests show.

Can pregnancy cause pulsatile tinnitus?

Yes. Pregnancy raises blood volume and the amount of blood the heart pumps, which reviews list as a cause of pulsatile tinnitus. It often fades after delivery. New headaches or vision changes during pregnancy still need prompt medical attention.

Does pulsatile tinnitus mean I am having a stroke?

Usually not. Most cases come from ear, blood flow, or vein causes that are not emergencies. Sudden pulsatile tinnitus with a severe headache, weakness, trouble speaking, or vision loss is different and needs emergency care right away.

Why Can I Hear My Heartbeat in My Ear?

The short answer: Hearing your heartbeat in your ear is called pulsatile tinnitus. Often the cause is simple: ear wax, fluid behind the eardrum, lying with one ear on a pillow, or a heart that is pumping harder than usual from anemia, pregnancy, an overactive thyroid, or exercise. Unlike ordinary ringing, pulsatile tinnitus usually has a cause a doctor can find, so a new, persistent whooshing in one ear deserves a checkup. A sudden onset with a severe headache, vision changes, or weakness needs emergency care.

What is pulsatile tinnitus, and how is it different from ringing?

Tinnitus is a sound you hear that has no outside source. The National Institute on Deafness and Other Communication Disorders (NIDCD) says surveys estimate that 10 to 25% of adults have it.

Pulsatile tinnitus is different. The sound beats in time with your pulse, often as a whoosh or thump. NIDCD notes that in these cases a doctor can sometimes hear the sound with a stethoscope, and that it often has an identifiable, treatable cause.

It is the less common type. A 2025 review in the Journal of Clinical Medicine puts pulsatile tinnitus at about 5 to 10% of all tinnitus cases. A 2022 review in JAMA Otolaryngology found that a thorough workup can identify a cause in more than 70% of patients.

The sound itself is real. Blood flowing near the ear always makes some noise. You notice it when flow gets louder, a vessel is abnormal, or your ear picks up internal sounds more easily.

What harmless things make you hear your pulse?

Ear wax or middle ear fluid. The 2025 review explains that any conductive hearing loss, including wax blockage or fluid behind the eardrum, can cause pulsatile tinnitus. Blocking outside noise lets body sounds carried through bone stand out. MedlinePlus lists ear noises, fullness, and partial hearing loss as common symptoms of a wax blockage.
Lying on one ear. Pressing an ear into a pillow blocks outside sound in the same way. A pulse you hear only in that position, which stops when you roll over, is usually the normal sound of blood flow.
A heart pumping harder. The review lists anemia, pregnancy, and hyperthyroidism as "high cardiac output" causes. More blood moving faster makes more noise. Hard exercise does the same thing briefly. If you wake with a pounding pulse, see our guide on waking up with your heart racing.
High blood pressure and some medicines. The same review names hypertension and medication changes as possible contributors.

High cardiac output causes tend to be heard in both ears. The review notes that for pulsatile tinnitus in both ears, doctors often check a complete blood count and thyroid tests first.

Which causes need a closer look?

Pulsatile tinnitus that stays in one ear, or that does not have an obvious simple cause, calls for a more careful search. Reviews group these causes into vascular and structural problems.

Idiopathic intracranial hypertension (IIH). This is raised pressure around the brain with no known cause. The 2025 review calls it the most common venous cause of pulsatile tinnitus. The National Eye Institute says it is most common in women ages 20 to 50, and that a BMI over 30 or recent weight gain raises the risk. It can also cause headaches, blind spots, and vision loss.
Venous sinus stenosis and vein variants. A narrowed or unusually shaped vein draining the brain can create turbulent, noisy flow.
Dural arteriovenous fistula. This is an abnormal connection between an artery and a vein in the covering of the brain. The 2025 review says some reports tie it to up to 20% of pulse-synchronous cases. Some fistulas can bleed, which is why doctors take care to rule them out.
Carotid artery disease. Hardened or narrowed arteries in the neck are a common arterial cause, mostly in older adults with heart risk factors. The review notes the narrowing usually must be significant, above 70%, to cause the sound. A tear in the artery wall (dissection) is another cause.
Glomus tumors (paragangliomas). These blood-rich tumors near the ear are the most common skull base tumor that causes pulsatile tinnitus. The review says up to 97% are benign, but they can still damage nearby structures.
Bone defects near the inner ear. Superior canal dehiscence, a thin or missing patch of bone over a balance canal, can make internal sounds loud. The 2024 Mayo Clinic review lists it with otosclerosis and patulous eustachian tube as non-vascular causes.

When is hearing your heartbeat in your ear urgent?

The JAMA review warns that pulsatile tinnitus can sometimes signal a risk of stroke or bleeding in the brain. Most cases are not emergencies, but some patterns are.

Call 911 or go to an emergency room if the whooshing starts suddenly along with any of these:

A sudden, severe headache
Weakness, numbness, drooping of the face, or trouble speaking
Sudden vision loss or double vision
Neck pain after an injury, a fall, or neck manipulation, which can point to an artery tear

Book a prompt visit (days, not months) if the sound is new and stays in one ear, comes with headaches that are worse lying down, comes with blurred or dimming vision, or comes with hearing loss or dizziness. Our guide to warning signs that need a doctor covers other red flags. If headaches are part of the picture, our headache types guide can help you describe them.

What does a doctor's evaluation involve?

The workup starts with questions and an exam, not a scan. Expect questions like these: Is it one ear or both? Did it start suddenly? Is it low-pitched and whooshing, or high-pitched? Does pressing on the side of your neck change it? The 2025 review notes that a low-pitched sound is often venous, while a high-pitched hiss is often arterial.

A typical evaluation includes:

An ear exam to look for wax, fluid, or a red mass behind the eardrum.
Listening with a stethoscope over the ear, neck, and skull for a bruit.
A hearing test (audiogram).
Blood tests such as a blood count and thyroid tests when a systemic cause is likely.
An eye exam to check for optic nerve swelling if IIH is possible.
Imaging when the cause is not clear from the exam.

Imaging is where pulsatile tinnitus stands apart. The 2014 American Academy of Otolaryngology clinical practice guideline strongly recommends against head and neck imaging for tinnitus. But it limits that advice to tinnitus that is not pulsatile, is in both ears, and has no neurologic signs or uneven hearing loss. Pulsatile tinnitus is one of the exceptions.

The 2025 review favors contrast MRI of the brain as the first scan for continuous pulsatile tinnitus with a normal ear exam. CT or CT angiography helps with bone problems and when MRI is not possible. The Mayo review says CT and MRI have similar diagnostic yield. A catheter angiogram is saved for cases where a fistula or artery problem is strongly suspected. For an overview of MRI and angiography, see mri.md.

Can pulsatile tinnitus be treated?

Often, yes, because treatment targets the cause. Removing wax or treating fluid can stop the sound. Correcting anemia or an overactive thyroid lowers the extra flow. IIH is treated with weight loss, medicine, or surgery, according to the National Eye Institute.

Many vascular causes can be treated from inside the blood vessels. A 2024 pooled analysis of 616 patients in World Neurosurgery found that venous sinus stenting improved pulsatile tinnitus in 91.7% of patients and fully resolved it in 88.6%. The sound came back in 6.5% of cases, more often in people with IIH. Fistulas may be treated with a catheter procedure or focused radiation. Tumors may be watched, removed, or treated with radiation.

The bottom line

Hearing your heartbeat in your ear is usually explained by something simple, like wax, fluid, pillow pressure, or a harder-working heart. Unlike ordinary ringing, it often has a findable cause. That makes a new, one-sided whoosh worth a doctor visit, and a sudden one with neurologic or vision symptoms an emergency.

Last updated: September 2026. This article is for informational purposes only and does not constitute medical advice. See a doctor or an ear, nose, and throat specialist for any new pulsing sound in your ear.