To understand “pulsatile tinnitus”, it is helpful to know the difference between the two main types of hearing loss: “conductive” and “sensorineural”.  Conductive loss is due to problems involving the ear canal, ear drum or middle ear; sensorineural loss involves problems of the inner ear.  With this in mind, people suffering from a condition causing conductive hearing loss (such as a perforated ear drum) might become more aware of sounds from inside their bodies.  Pulsatile tinnitus occurs when the ear becomes aware of a change in blood flow in nearby blood vessels, including the arteries and veins in the neck, base of the skull, and in the ear itself.  The rhythmic noise beats in time with the pulse.