Objective pulsatile tinnitus on a vascular basis is a relatively uncommon auditory phenomenon. There are other forms of objective tinnitus which will not be covered in this discussion. The most common lesions are arteriovenous malformations near the temporal bone which are branches of the external carotid artery, such as the occipital artery, to the transverse or sigmoid sinus. Diagnostically, a patient can be entirely asymptomatic except for a pulse-synchronous objective tinnitus in one ear. There is usually no associated hearing loss, vertigo, imbalance or pressure. A sense of fullness may not be a constant problem but may be intermittent. The objective pulsatile tinnitus may not be a constant problem but may come and go for no apparent reason.