Pulsatile tinnitus can often be a diagnostic problem. This communication reports the authors' experience on 100 patients with pulsatile tinnitus and describes a practical and effective diagnostic approach. Better understanding of the various etiologies of pulsatile tinnitus, coupled with the introduction of magnetic resonance angiography, in conjunction with magnetic resonance imaging, have made a major impact on the evaluation of this symptom in recent years. Cerebral angiography, previously performed on the majority of patients, is presently indicated in selected cases only. Intracranial hypertension, glomus tumors, and carotid atherosclerosis were the most common diagnoses made in our patients.