ABSTRACT
Pulsatile tinnitus coexists with patient's heartbeat and objective tinnitus is audible to other persons such as examiner. It can be disagreeable for the patient and can also be the only clue to a potentially devastating and life-threatening disease. Pulsatile tinnitus with a normal otoscopic examination often presents a diagnostic challenge, and its differential diagnosis includes a wide range of conditions. Evaluation of a patient with tinnitus requires a detailed history, a comprehensive audiological evaluation with hearing thresholds, neuro-otological physical examination with otoscopy and imaging studies. We recently experienced a case of a 28-year-old male complaining of right-sided pulsatile tinnitus. The tinnitus was objectively audible at the left side of the posterior neck. Non-contrast enhanced computed tomography of temporal bone showed a high jugular bulb on the left side. A 6-vessel angiography showed prominent left paravertebral venous plexus and prominent venous plexus around the skull base.