More and more people have experienced pulsatile tinnitus and it causes too much trouble. What causes pulsatile tinnitus? The most common cause is vascular, and it is difficult to determine whether it is physiological or pathological. The most common cause is due to coexisting hypertension with atherosclerosis or arterial vortex phenomenon caused by twisting of blood vessels. Effective control of hypertension can reduce or eliminate tinnitus. Other causes include arterial aneurysms, arteriovenous fistulas, and jugular vein bullae, with malformations of the mastoid vein and high jugular vein bullae being the most common. Arteriovenous fistulas are diagnosed when the head is turned to the opposite side of the tinnitus and the tinnitus is relieved by compression of the jugular vein on the affected side.