A thumping sound in the ear may be due to pulsatile tinnitus. There are two types of pulsatile tinnitus, vascular and non-vascular. Vascular pulsatile tinnitus is the most common and can be suspected when the thumping in the ear is consistent with the beating of the heart. Alternatively, compression of the jugular vein and mastoid area may be used to see if the tinnitus disappears or is reduced, and if it disappears, the tinnitus is of jugular vein origin. Hearing tests and imaging tests are usually required to confirm a diagnosis of pulsatile tinnitus, and prompt medical examination is recommended.