Tinnitus is a symptom defined as the perception of noise in the absence of an acoustic stimulus. Tinnitus is most commonly heard as a ringing, buzzing or hissing sound. Approximately 4% of patients with tinnitus, however, describe the sound as a pulsing noise. Pulsatile tinnitus that is the same rhythm as a person’s heartbeat is known as pulse-synchronous tinnitus (PST). There are multiple causes for PST. Sigmoid sinus dehiscence and sigmoid sinus diverticulum (also known as sigmoid sinus wall abnormalities) are some of the more commonly identified causes for PST. This article will discuss some of the causes of PST, with an emphasis on the diagnosis and treatment of sigmoid sinus wall abnormalities.