Pulsatile tinnitus (PT) may often present a diagnostic and management dilemma to the Otolaryngologist. The incidence of this symptom has increased in the last decade, most likely due to the obesity epidemic, and can be associated with serious conditions such as idiopathic intracranial hypertension, arteriovenous fistulae, and spontaneous cerebrospinal fluid leaks. An academy favorite for more than 30 consecutive years, this session provides a wide overview of the etiology, presentation, evaluation, and management of patients with pulsatile tinnitus. Upon completion of the session, the attendees will be able to distinguish between objective and subjective tinnitus, determine arterial versus venous etiologies, and feel comfortable in the proper radiologic workup and medical/surgical management. Ample time will be provided for questions from the audience.