Ringing inside the ear like a heartbeat may be related to physiological factors such as excessive fatigue, poor rest, etc. It may also be related to pathological factors such as acute vascularization, jugular vein bulboma, etc. 1. Physiological factors: If it occurs occasionally and transiently, daily emotional tension, high pressure, poor rest, excessive fatigue, etc., will lead to the appearance of ringing inside the ear like a heartbeat, but usually occasional, transient. 2. Pathologic factors: (1) Vascular malformations: congenital vascular malformations: such as embryonic internal carotid artery dysplasia, vascular stenosis, can be due to blood flow disorders in the area, or pharyngeal ascending artery blood flow increases, causing pulsatile tinnitus. Acquired vascular malformations are mostly caused by trauma, surgery, infection, tumor, pregnancy and other causes of meningeal or venous sinus thrombophlebitis. (2) Jugular vein glomeruloma: the main reason is still unclear, rays, pesticides, paints, formaldehyde, etc. may induce the disease, often showing throbbing tinnitus, hearing loss, etc., which may lead to the appearance of ringing in the ears like a heartbeat. If there is a ringing in the ears like a heartbeat, if it is occasional and transient, it is recommended to improve living habits, if it is a long time, it is recommended to choose to consult a doctor for a clear diagnosis.