Benign Intracranial Hypertension (BIH): Also known as idiopathic intracranial hypertension, this condition is characterized by increased intracranial pressure without a detectable cause. It often presents with symptoms such as headache, vision changes, and pulsatile tinnitus, which can be intermittent. The pulsatile nature of the tinnitus is due to the transmission of intracranial pulse waves to the auditory system.

Middle Ear Problems: Conditions affecting the middle ear, such as a middle ear infection or otosclerosis, can cause intermittent pulsatile tinnitus. The abnormal sound is often a result of the altered middle ear function affecting sound conduction.
Vascular Tumors or Malformations: Tumors or malformations of blood vessels near the ear, such as glomus tumors, can cause pulsatile tinnitus due to the abnormal blood flow patterns.
Carotid Artery Stenosis or Atherosclerosis: Narrowing or hardening of the carotid arteries can lead to turbulent blood flow, which may be perceived as pulsatile tinnitus.

Giant Cell Arteritis: This is an inflammatory disease affecting the blood vessels, particularly those in the head. It can lead to severe complications, including blindness, if not promptly treated. While less common, it's crucial to consider due to its potential severity.
Dural Arteriovenous Fistula (DAVF): An abnormal connection between arteries and veins in the covering of the brain can cause pulsatile tinnitus. DAVFs can lead to serious neurological deficits if not treated.
Vascular Dissection or Aneurysm: Tears or bulges in the blood vessel walls can lead to abnormal blood flow, potentially causing pulsatile tinnitus. These conditions require immediate medical attention to prevent severe outcomes.

Paget's Disease of Bone: A chronic condition that can result in enlarged and misshapen bones, potentially affecting the temporal bone and leading to pulsatile tinnitus.
Ototoxicity from Certain Medications: Some medications can cause damage to the ear, leading to tinnitus. While not typically pulsatile, in rare cases, it could present as such.
Thyroid Abnormalities: Both hyperthyroidism and hypothyroidism have been associated with tinnitus, though the mechanism is not fully understood and it is less commonly pulsatile.