Tinnitus is one of the commonest ENT symptoms. The diagnostic process and management of the tinnitus is a challenge. Elderly people are more likely to suffer from tinnitus. We should ask the patient if they have bilateral or unilateral tinnitus, how loud are these, if the tinnitus is pulsatile or non-pulsatile, history of exposure to loud noises or working in a noisy environment, the impact of tinnitus in the quality of life, medication history, and if they have noticed what makes tinnitus worse. History of tinnitus accompanied by vertigo may raise concerns for Meniere’s disease, intracranial lesions, and autoimmune ear disease. Visual problems (transient visual blurring, vertical diplopia-cranial nerve VI paresis, brief episodes of blindness, or seeing light flashes), combined with headaches and usually pulsatile tinnitus, are indicative of benign intracranial hypertension (Pseudotumor cerebri). Pulsatile tinnitus may be also related to vascular abnormalities, head and neck tumors, hypertension, atherosclerosis, paragangliomas, hyperthyroidism, and anemia. Non-synchronous pulsatile tinnitus may be related to palatal myoclonus.