Pulsatile tinnitus is produced by the blood vessels or muscles in the patient’s head and neck and is perceived by conduction through the bones, blood vessels and blood flow to the cochlea. It is usually associated with vascular lesions such as jugular venous bullae, intracranial and extracranial vascular malformations, dural arteriovenous fistulas, atherosclerosis, etc. Alternatively, non-vascular pulsatile tinnitus is associated with myoclonus in the head and neck, such as palatal myoclonus, stapedius muscle or tympanic tensor muscle myoclonus.