Can Vitamin B12 Deficiency Cause Pulsatile Tinnitus?

January 7, 2026 •

4 min read

While pulsatile tinnitus is often linked to vascular issues, a growing body of research suggests a connection to nutrient shortfalls. Vitamin B12 deficiency, in particular, has been flagged as a potential, though not primary, contributor to hearing disturbances, including tinnitus. Understanding this link requires examining the vital role B12 plays in the nervous system and overall ear health.

Quick Summary

This article explores the connection between vitamin B12 deficiency and pulsatile tinnitus. It details the mechanisms by which a lack of this nutrient can affect auditory and nervous system function, contributing to the development of tinnitus symptoms. The content covers the role of myelin, red blood cell production, and homocysteine levels. It also compares nutritional causes with more common vascular culprits and discusses diagnostic steps.

Key Points

Indirect Link: B12 deficiency can contribute to pulsatile tinnitus by causing anemia, which leads to turbulent blood flow near the ear, rather than being a direct cause.
Nervous System Damage: A lack of B12 can damage the auditory nerve's protective sheath (myelin), disrupting nerve signals that the brain may misinterpret as sound.
Increased Homocysteine: Low B12 levels elevate homocysteine, an amino acid that can damage blood vessels and contribute to vascular issues in the inner ear.
Not the Only Cause: Many other factors, such as high blood pressure, atherosclerosis, and certain tumors, are more common causes of pulsatile tinnitus and must be ruled out by a doctor.
Treatment Focus: If a B12 deficiency is confirmed, treatment involves correcting the nutritional imbalance through diet, supplements, or injections, which can help improve or resolve associated tinnitus symptoms.
Medical Evaluation is Key: Due to the variety of potential causes, anyone experiencing pulsatile tinnitus should seek a comprehensive medical evaluation to identify and treat the correct underlying condition.

Pulsatile tinnitus, a condition characterized by a rhythmic whooshing or throbbing sound in the ear that syncs with one's heartbeat, can be a symptom of various underlying health issues. While it is most commonly associated with vascular problems, a nutritional deficiency, specifically of vitamin B12, is a potential—albeit less common—contributing factor. The relationship is complex, involving both the nervous and vascular systems, which are heavily influenced by adequate B12 levels.

How Vitamin B12 Impacts Auditory Health

Vitamin B12, or cobalamin, is crucial for maintaining the health of the central and peripheral nervous systems. A shortage of this vital nutrient can lead to neurological damage, including demyelination, which is the breakdown of the protective myelin sheath surrounding nerve fibers. The auditory nerve, which carries sound signals from the inner ear to the brain, is susceptible to this damage. Impaired nerve signaling can cause the brain to interpret abnormal electrical activity as sound, a phenomenon that can manifest as tinnitus.

The Role of B12 in Red Blood Cell Formation

Vitamin B12 is also essential for the production of healthy red blood cells. A deficiency can lead to megaloblastic anemia, where the body produces abnormally large red blood cells that cannot function properly. Anemia forces the heart to work harder to circulate oxygen throughout the body, leading to increased blood flow velocity. If this turbulent blood flow occurs in vessels near the ear, such as the carotid artery or jugular vein, it can be perceived as pulsatile tinnitus.

Homocysteine and Vascular Effects

Another key mechanism involves homocysteine, an amino acid whose levels are regulated by vitamin B12 and folate. When B12 levels are low, homocysteine can accumulate in the bloodstream, leading to inflammation and damage to blood vessels. This vascular damage can affect the tiny blood vessels in the inner ear, known as the stria vascularis, which are critical for hearing. The resulting dysfunction can contribute to hearing problems, including tinnitus. High homocysteine levels have also been linked to vascular diseases that can cause turbulent blood flow, a direct trigger for pulsatile tinnitus.

Other Common Causes of Pulsatile Tinnitus

While B12 deficiency can play a part, it is important to consider other, more frequent causes of pulsatile tinnitus, as addressing the underlying condition is key to finding relief.

High Blood Pressure (Hypertension): Increased force of blood flow against artery walls can be audible in vessels near the ear.
Atherosclerosis: Hardening of the arteries due to plaque buildup can create noisy, turbulent blood flow.
Anemia (General): Severe anemia from any cause forces the heart to pump harder to compensate for reduced oxygen-carrying capacity, creating turbulent blood flow.
Turbulent Blood Flow: Conditions like venous sinus stenosis or arteriovenous malformations can disrupt blood flow in the head and neck.
Idiopathic Intracranial Hypertension (IIH): Elevated pressure in the fluid surrounding the brain can cause pulsatile tinnitus, often in conjunction with headaches and vision issues.

Diagnosing and Treating B12-Related Pulsatile Tinnitus

If B12 deficiency is suspected, a healthcare provider can conduct simple blood tests to measure your vitamin B12 levels, and sometimes other markers like methylmalonic acid (MMA) and homocysteine. A comprehensive evaluation by an ear, nose, and throat (ENT) specialist or a neurologist is crucial to rule out other causes through imaging studies or hearing tests.

A Comparison of Tinnitus Types and Causes


Feature	Pulsatile Tinnitus	Non-Pulsatile (Subjective) Tinnitus
Sound	Rhythmic, throbbing, or whooshing, often synchronized with heartbeat.	Ringing, buzzing, hissing, or clicking; constant or intermittent.
Primary Cause	Usually a vascular issue (e.g., blood flow changes).	Damage to inner ear hair cells, noise-induced hearing loss, or age-related hearing decline.
B12 Connection	Indirectly via anemia and vascular effects.	Directly via demyelination of the auditory nerve.
Treatment Focus	Addressing the underlying vascular or medical issue.	Masking sound therapy, cognitive behavioral therapy (CBT), stress reduction.

Treatment for B12 deficiency-related pulsatile tinnitus focuses on correcting the nutritional imbalance. This can be achieved through:

Dietary Changes: Increasing intake of B12-rich foods like meat, fish, eggs, and dairy. Fortified cereals and nutritional yeast are options for vegetarians and vegans.
Oral Supplements: Over-the-counter or prescription supplements can help correct mild to moderate deficiencies.
Injections: For severe deficiencies or malabsorption issues, regular intramuscular B12 injections may be necessary. Studies on B12 supplementation for tinnitus have shown positive outcomes specifically in patients who were deficient in the vitamin.

Conclusion

While vitamin B12 deficiency can contribute to the development of pulsatile tinnitus, it is typically a result of its effect on the nervous and vascular systems rather than a direct cause. The pulsing sound, unlike the more common subjective tinnitus, is usually tied to turbulent blood flow, which can be exacerbated by conditions like anemia caused by B12 deficiency. However, correcting the deficiency with supplements or injections, particularly in diagnosed cases, has been shown to alleviate symptoms. It is essential to consult with a healthcare provider for proper diagnosis, as many other, more serious conditions can cause pulsatile tinnitus. A thorough medical evaluation ensures the correct underlying issue is identified and treated effectively.

For more detailed information on tinnitus and related auditory conditions, consult authoritative sources such as the American Tinnitus Association (ATA).

Frequently Asked Questions

B12 deficiency can lead to anemia, causing the heart to pump blood with more force and velocity. This turbulent blood flow in vessels near the inner ear can be perceived as the rhythmic sound of pulsatile tinnitus.

Pulsatile tinnitus is a rhythmic sound, often a whooshing or throbbing, that is in sync with your heartbeat. Non-pulsatile tinnitus is more commonly a constant ringing, buzzing, or hissing sound.

If a diagnosed B12 deficiency is the underlying cause, correcting it with supplements or injections can lead to improvement or resolution of symptoms. However, it is not a universal cure and only helps if the deficiency is the root issue.

Other common causes include high blood pressure, atherosclerosis (hardening of the arteries), anemia from other causes, vascular abnormalities, and idiopathic intracranial hypertension (IIH).

In addition to tinnitus, B12 deficiency can cause neurological symptoms like tingling or numbness in the hands and feet, memory problems, confusion, vision problems, and a loss of physical coordination.

A doctor can diagnose B12 deficiency with a simple blood test. They may also check for related markers, like homocysteine and methylmalonic acid (MMA), for a more complete picture.

You should see a doctor as soon as possible if you experience pulsatile tinnitus. While it can be benign, it can also be a sign of a more serious underlying medical condition, so a proper diagnosis is essential.