Pulsatile tinnitus consists of a rhythmic sound in one or both ears that is synchronous with the heartbeat. In some cases, pulsatile tinnitus is due to an anomaly of a blood vessel, which may be identifiable on special vascular imaging studies. A patient with pulsatile tinnitus in whom a vascular cause is suspected often consults with a vascular neurosurgeon to determine the appropriate imaging study and whether intervention is appropriate.