Pulsatile tinnitus is a rare form of tinnitus characterized by pulsatile sound that is synchronous with the heartbeat. Unlike idiopathic non-pulsatile tinnitus, an underlying vascular cause may be identified. Common causes include carotid artery atherosclerosis, Arteriovenous malformation or fistulae or vascular tumours. It should be thoroughly investigated using magnetic resonance angiography, computer tomography venography or traditional angiography. Many aetiologies are amenable to either angiographic or surgical intervention.