A previously healthy 44-year-old woman presented with new-onset hearing loss and a 4-month history of pulsatile tinnitus in her right ear. She stated that she was not taking any new medications and had no recent upper respiratory infections, vertigo, chronic otitis media, head trauma, or history of hypertension. Her medical history was significant only for asthma and gastroesophageal reflux disease. She noted that the tinnitus was continuous, pulsatile, and humming in nature and that it stopped when she applied pressure to the right side of her neck. She stated that it was significantly worse at night, complaining that some nights she got little to no sleep.