A 72-year-old man presented to his primary care provider with a complaint of a pounding sound that he described as inside his right ear.

An examination of the ear did not reveal any abnormality. The patient had mild hearing loss from years of working around machinery, but otherwise the ear itself was normal. Upon further examination, he was found to have a significant bruit in the right carotid artery. Carotid Doppler and magnetic resonance angiography (MRA) revealed significant vascular flow impediment throughout his cerebrovascular system.

The sound he was hearing is referred to as pulsatile tinnitus. The condition is considered serious because it indicates that the patient is at high risk for a catastrophic event such as a stroke. In this case, the patient not only subsequently had a stroke 2 years later, but he also required coronary artery bypass surgery within 5 years. 

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