Tinnitus is one of the most common otological symptoms encountered in Otorhinolaryngology. In recent times our understanding of tinnitus has significantly progressed but nonetheless, it still constitutes a very incapacitating symptom which greatly affects the quality of life. Objective tinnitus accounts for only 5% and has various aetiologies both non-otological & otological which include both non vascular and vascular. Vascular malformations like Dural Arteriovenous Fistulas (DAVFs) constitute about 10% of objective tinnitus and hence are of academic interest to an Otolaryngologist due to their scarcity.

We present one such exceptional case, where a 26 year old female presented to ENT out-patient department with chief complaints of a left pulsatile tinnitus for duration of 2 months. A thorough clinical examination revealed no abnormality. A Pure Tone Audiometry was then done which showed hearing of patient is within normal limits.

DAVFs, although infrequent, constitute a treatable cause of tinnitus and hence should be considered as a possible diagnosis in all patients with pulsatile tinnitus, especially if it is unilateral. We also carried out a review of the current medical and surgical management in an attempt to better understand this rare yet interesting condition.