Doctor Q&A: Is that sound coming from my ear a sign of high blood pressure? Doctor Renée answers your burning health questions

Hi Dr Renee, I hope you are well. A few months ago I was put on medication for high blood pressure. It has come down a little but is still too high. I have noticed that when it's quiet I hear a pulsing sound in my left ear, a humming sound that copies my heartbeat. Could this be because of my high blood pressure? Kind regards

To address the blood pressure before that actual question, if your blood pressure tablets are not bringing your blood pressure into range then you need to change them, increase the dose or add another one to them.

There is no point being on a tablet if they aren’t doing the job! It would also be remiss of me not to mention the many things you can do to bring down blood pressure naturally which I have covered in previous weeks, but essentially, exercise, weight loss, beetroot juice and a healthy non non-processed diet are a great start.

Most importantly today, however, it is important to address the pulsatile tinnitus (PT) which is what you are describing with the pulsing sound in your left ear. When in just one ear it is called unilateral PT and when in both, bilateral.

You are right to worry about your blood pressure being the cause as it can indeed be due to blood flow changes in the blood vessels. This can include the large arteries and veins at the base of the skull, and the smaller arteries and veins in the ear.

This is the reason that you should always discuss PT with your GP, so please do, as changes to blood flow are not the only cause.

Problems in the ear can exaggerate the sounds being heard and these naturally include perforated eardrums, fluid behind the ear drum, and ear infections.

Things that may affect the blood flow and cause PT, include:

• Unmanaged hypertension
• Anaemia
• Pregnancy
• Exercise
• Atherosclerosis (fatty collections in the blood vessels)
• Thyrotoxicosis; when a person has too much thyroid hormone.
• Rarely a tumour can interrupt or increase blood flow in blood vessels which can be heard as pulsatile tinnitus.

So, working to my normal position, that common things are common, you will most likely find a simple explanation for your new symptoms but it needs investigating, so please see your GP who will likely do all or some of these:

• Take your medical history, including a history of tinnitus
• Conduct a physical exam of your neck, skull, and eardrums.
• Using an otoscope to look inside your ears
  
• Conduct hearing tests
• Order blood tests
• Order a scan of your head and neck

I hope that this helps and good luck!

Hello Dr Renee, is it normal for a four-year-old to not talk properly? My son barely speaks and when he does, he struggles to express himself. Would really appreciate your opinion. Thank you

Children’s speech is very individual and they will all develop at different ages, my son for example had words at six months but my daughter waited until 15 months! So, the first thing to realise is that there is no one size fits all.

Having said this, certain milestones should raise a flag if not met and it may be good for you to download an excellent app from the CDC.

Here you can follow through simple questions about your child and see if they are meeting or missing milestones and when to flag those not being met. It is American but still tells you what you need to know and it takes account of the wide variation child to child.

Your son is four so it would be reasonable to assume he has contact with other children and carers at nursery or playgroup, have they raised an issue? If so, have they referred? Did they have their health visitor one and two-year checkup? Were there any issues raised then or are these new?

It would be useful to speak to your Health visitor and your GP can signpost you to yours and give you their contact details.

There are many things that need to be consider when a child isn’t speaking much or the speech is difficult to understand. It is important for example, to consider hearing. If a child can’t hear properly, they can’t learn to speak properly, so a simple hearing test can be organised by your GP to assess this. It may for example be glue ear, a treatable and common problem which impacts speech.

Jaw and tongue problems are rare but can impede proper sound formation so it should be considered and dentists can assess.

More serious issues may include autism spectrum disorder which will need a more formal assessment but sooner rather than later is key and your GP can help.

I also wondered if your little one is a Covid mask victim and during his formative speech and emotional years he was looking at masked carers and this has affected speech. As sad as this is, it can be remedied and he can be helped to reach his potential.

Overall, I would say that it is impossible for me to comment on your son individually without meeting and assessing him so please speak to your GP as soon as possible and in the interim do everything you can to encourage speech:

• Help him associate sounds with pictures; look at a cat and meow together, make the ding-dong sound for the doorbell.
• Give clear instructions in a game of give and take; ‘give me the car’ and then reverse so that he gives you an instruction
• Speak with and at your child constantly and introduce new words, demonstrating them and encouraging repetition.
• If he uses shortened words, don’t scold, just correct the word each time (my 6 year-old still says ‘Fuman’ instead of Human, we correct her every time).
• Read books together and name objects together
• Sing simple songs.
• Listen to nursery rhymes and sing along

I know these things sound simple but every bit helps and if he did miss out due to masks, he may just need a little help to get back on track.

If he is starting school in September, see the teacher immediately and ask for their assessment. Alongside this, please speak to your GP as soon as possible to get things rolling, even if it is to put your mind at rest.

Hi Doctor Renée. I have terrible IBS symptoms and they are making life really difficult for me. I often have constipation and then diarrhoea and my GP keeps telling me to lower my stress levels. The IBS itself stresses me, are there any other suggestions?

I am sorry to hear this and how impactful IBS is for you.

For those who don’t know, IBS, or irritable bowel syndrome is a group of symptoms that affect the digestive system and cause abdominal pain and cramps with diarrhoea, constipation or both and often bloating that is relieved after a bowel emptying. The difference between IBS and IBD (inflammatory bowel disease) is that IBS doesn’t cause tissue damage in your digestive tract or increase your risk of colon cancer. However, it is a chronic (long-term) condition that needs to be managed, often by changing routines, the food eaten, adding medications as needed and sometimes using behavioural therapies like CBT.

There are three main categories of IBS:

• IBS with constipation (IBS-C): Most stools are hard and lumpy.
• IBS with diarrhoea (IBS-D): Most stools are watery and loose.
• IBS with mixed bowel habits (IBS-M): Stools are mixed between the above types

Everyone with IBS is unique and their symptoms will vary and be triggered and controlled by different foods/drinks/habits and medications. The most important starting point is a proper diagnosis.

A very good test for IBS is a stool (poo) sample called Faecal Calprotectin. This can differentiate well between IBS and IBD. Alongside this, ruling out stomach bacteria, heliobacteria pylori, is important and if there is any doubt, a colonoscopy (camera into the bowel) to have a look/take a biopsy.

IBS is the most common gastro disorder seen by GPs and gastroenterologists and generally involves a combination of treatments tailored to the patients. This includes:

Food changes

• Increase fibre
• Look at the FOADMAP diet and if there are foods on there that seem to trigger symptoms then cut them out, one at a time, for two weeks and see if things improve. I will get in trouble with the FODMAP designers by telling you to use it as a test guide rather than follow it, but there are so many foods on it that I think it’s too hard to follow entirely if not needed!
  
• Drink plenty of water
• Keep a food diary to track symptoms

Activity

• Exercise regularly
• Get enough sleep
• Try relaxation techniques; yoga, acupuncture

Aimed at helping you deal with stress levels and the symptoms which are blighting life.

• Cognitive behaviour therapy
• Biofeedback techniques
• Hypnotherapy

Whilst there is mounting evidence for gut microbiome playing a role in IBS, more evidence is needed. There are so many probiotics on offer that it can be confusing.

Having looked into it, there is evidence coming out of Kings College regarding Symprove and IBS. The work is ongoing but combined with lifestyle intervention, a daily dose of Symprove seems to help many with IBS.

I think the overall message is, don’t suffer in silence. It may take time to find your solution and a combination of solutions and a simple probiotic won’t do harm and may help significantly.