Pulsatile tinnitus often presents a diagnostic and management dilemma to the neurotologists. Correct diagno­sis is imperative because in the ma­jority of cases.there is a treatable un­derlying etiology. In addition, failure to make proper diagnosis may be disas- ' trous because in some patients, a life-threatening intracranial disease may be present.This study was car­ried out aiming to investigate the fea­sibility of differentiating the possible causes of pulsatile tinnitus.particularly in patients with normal otoscopy, us­ing clinical, audiological and radiologi­cal tools. 29 patients complaining of pulsatile tinnitus were evaluated by history taking, clinical examination, la­boratory investigations, otoscopy, ba­sic audiological evaluation, MRI for petrous bone and brain and MRA. Glomus jugulare tumor was diag­nosed in 3 patients. Benign intracrani­al hypertension (BIH) was diagnosed in 4 patients. Intraventricular neo­plasm in 2 patients. Internal carotid artery stenosis in one patient. Post-traumatic pseudoaneurysm in one pa­tient. Scalp AVM in one patient. Tem­poral bone metastasis in one patient. Severe anemia in one patient and no identifiable cause(idiopathic) in 15 pa­tients. A unilateral mild low frequency pseudosensorineural hearing loss was identified in 10 patients with nor­mal otoscopy.Hearing loss was nor­malized after elimination of tinnitus by applying a light digital pressure over the ipsilateral internal jugular vein.