Dear Doctor: A few months ago, I started to hear pulsating sounds in my head. I finally came to realize it was my blood pulsing. The sound is always there, but really only noticeable when I'm in bed or sitting quietly. Is it anything to worry about? Will it ever go away?

Dear Reader: What you're describing sounds like the symptoms of pulsatile tinnitus. Tinnitus is normally perceived as a ringing, buzzing or whistling sound in the ear. Pulsatile tinnitus, however, is a pulsing sound synchronous to the heartbeat. It occurs in less than 10 percent of people who have tinnitus. I have had patients, and a family member, with pulsatile tinnitus, so I understand how intrusive and irritating the sounds can be, especially when one lies down at night. Usually, this type of tinnitus is heard in just one ear.

The biggest issue with pulsatile tinnitus is finding the source. Often the pulsing sensation is caused by malformations between the arterial system and the venous system and the ensuing turbulent blood flow that occurs when blood moves from a high-pressure system, the artery, to a low-pressure system, the vein.

Pulsatile tinnitus can also occur when the temporal bone transmits the sound of a nearby artery -- or from more serious conditions, such as when a nearby artery suffers an aneurysm, when a carotid artery narrows, or when a person develops a paraganglioma (a tumor that can occur in the neck and in the head). Often, these tumors are located near blood vessels and have a good blood supply, leading to turbulent blood flow that is audible not only to the person but also sometimes the doctor. Elevated blood pressure in the brain and anemia can play a role in pulsatile tinnitus as well.

Due to concerns about aneurysms, malformations, narrowing of the carotid artery and paragangliomas, it is important to try to identify the cause of the pulsatile tinnitus. Diagnostic testing can detect an underlying cause in 70 percent of patients. To get to a diagnosis, your doctor will need to take a thorough history and do a focused examination.

Radiologic tests then may be necessary to find the cause. An MRI of the brain with MR angiography can identify vascular abnormalities and brain tumors. A CT scan with angiography can also identify vascular lesions and tumors, but not as well as an MRI. One differentiating benefit with a CT scan is that it can identify bony lesions near the ear that would lead to pulsatile tinnitus.

So, I wouldn't ignore the sounds you're hearing. You should make an appointment with your primary care doctor or an ear, nose and throat doctor to evaluate the cause of your symptoms. They may recommend imaging to try to identify the cause, as well as treatment for some of the conditions related to pulsatile tinnitus. Then, finally, you may find relief from this irritating symptom.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: What's the deal with the tick bite that makes you allergic to meat? Will I know if it happens to me?

Dear Reader: Sounds like science fiction, right? A single tick bite scrambles your immune system so that overnight you become allergic to foods you've been eating your entire life. But unfortunately for a small but growing number of people in the United States, this scenario is all too real.

The culprit is the Lone Star tick, which is widely distributed throughout the Eastern, Midwestern and Southeastern states. Recent studies suggest that the tick may be on the move. It has been identified as far north as New York state and Maine, and as far west as Texas. It gets its name from the single splotch, or "star," that the adult female has on her back.

It was in 2009 that scientists first began to connect the dots between the Lone Star tick and a rather unusual immune response. Certain people who were bitten by the tick went on to develop a sudden and sometimes quite serious allergy to red meat. This includes beef, lamb and pork.

Something in the tick bite sends alarm bells ringing in the immune system, ordering it to target a specific carbohydrate found in meat. The full name is galactose-alpha-1,3-galactose, but it's commonly shortened to alpha-gal.

The specific agent that causes the allergy, be it a microbe or a biological compound found in the tick's saliva, is under study. So far scientists have been left with far more questions than answers. This includes whether the sensitivity to alpha-gal can be reversed.

In most food allergies, the physical response is swift. Eat a strawberry and a few minutes later, you break out in hives. With the alpha-gal allergy, however, it can take the body up to 12 hours to react. The slow onset of alpha-gal allergy symptoms can make the diagnosis a challenge.

The most common symptoms are stomach pain, nausea, hives, skin rash, sneezing, headaches and wheezing. In severe cases, anaphylactic shock is possible. The allergic reaction can happen after just a single bite of meat. It has also been observed in people taking medications that contain gelatin, as well as those using new cancer drugs derived from genetically modified mice.

The recent spread of the alpha-gal allergy beyond the traditional borders of the Lone Star tick's range has scientists questioning whether other species of ticks may also be involved. If you've recently been bitten by any tick and suspect you may have developed an alpha-gal allergy:

-- Stop eating red meat or any other foods that trigger symptoms.

-- Know that some symptoms can be controlled with antihistamines and corticosteroids.

-- For severe reactions, including anaphylaxis, use injected epinephrine, which requires a prescription.

For an accurate diagnosis, make an appointment with an allergist. He or she will want to know:

-- What you ate that triggered the symptoms.

-- The time frame in which symptoms appeared.

-- The specifics of the symptoms and how long they lasted.

A blood or skin test will show whether food-specific antibodies are present. Your allergist will use the results of these tests to arrive at a diagnosis.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Is there any treatment besides surgery that can reliably help an older man urinate when he is experiencing difficulty due to prostate enlargement?

Dear Reader: This common problem becomes all the more common as men get older. In fact, 40 to 50 percent of men ages 51 to 60 -- and up to 80 percent of those over 80 -- have prostate enlargement. Slightly more than half suffer symptoms, which include poor urine flow, frequent urination, incomplete emptying of the bladder and, most irritatingly, waking up multiple times at night to urinate. Some of these symptoms can be improved by decreasing alcohol and caffeine and by decreasing evening fluid intake.

Drug treatment is the first line of therapy. Alpha-1 receptor blockers work to relax the smooth muscles in the prostate and the lower portion of the bladder. This relaxation allows the urine to flow more easily from the bladder. The biggest side effect is lightheadedness, because the drug also lowers blood pressure. This lightheadedness has not been reported as much with newer formulations -- tamsulosin, alfuzosin and silodosin -- that improve urine flow and reduce frequency because they're more selective to the urinary tract.

Another option is to decrease prostate size with a medication -- finasteride or dutasteride -- that reduces the formation of the hormone dihydrotestosterone, or DHT. This hormone stimulates the prostate to grow; the medications work by inhibiting the enzyme that produces it. Note, however, that these drugs can take six months to one year to reduce symptoms; the biggest side effects are a lowered libido and, less commonly, erectile dysfunction.

A daily 5-milligram dose of the erectile dysfunction drug Cialis can also reduce symptoms of an enlarged prostate. Lastly, in those who don't retain urine in the bladder, anticholinergic medications such as tolterodine and oxybutynin help relax the bladder and decrease the desire to urinate. The problem with these medications is that they have more side effects, including dry mouth, blurred vision, drowsiness, constipation and impairment of mental function.

Because you mention surgery, I assume that you've already been given medication for your symptoms and are now confronting the prospect of a more radical intervention. The most common surgery for prostate enlargement is a transurethral prostatectomy. In this surgery, a urologist removes a portion of the prostate via the urethra. The transurethral prostatectomy is well-tolerated with minimal side effects, but if you're looking for a less invasive procedure, there are alternatives.

One alternative form of surgery -- known as focused laser ablation -- vaporizes prostate tissue with light waves. This eases symptoms immediately, has less blood loss than traditional surgery and has a recovery time of only two to three days. Although this procedure treats a smaller portion of the prostate, and symptoms may occur again at a later time, early research is supportive of this option. A European study in 2016, for example, showed that the benefits of this treatment lasted more than two years. Similar procedures use water vapor or even microwaves. All of these have fewer side effects than traditional surgery and have been shown to be effective.

Medications are obviously the first choice for symptoms of prostate enlargement. But if those don't work, there are less invasive procedures than traditional surgery.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)