Tinnitus: This is the most common diagnosis for pulsing in the ears, often described as a ringing, buzzing, or pulsing sound without an external source. It can be related to exposure to loud noise, age-related hearing loss, or certain medications.

Anxiety or Stress: High levels of anxiety or stress can cause or exacerbate tinnitus, leading to the sensation of pulsing in the ears.
Hypertension: High blood pressure can cause blood vessels to become more pronounced, potentially leading to pulsatile tinnitus, where the pulsing sound is in sync with the patient's heartbeat.
Middle Ear Problems: Issues such as a middle ear infection or otosclerosis (a condition that affects the middle ear bones) can cause pulsing sensations in the ears.
Eustachian Tube Dysfunction: The Eustachian tube connects the middle ear to the back of the nose and throat. Dysfunction of this tube can lead to feelings of fullness or pulsing in the ears.

Carotid Artery Stenosis or Aneurysm: Although less common, pulsatile tinnitus can be a symptom of a carotid artery stenosis or aneurysm, which are serious conditions that require immediate medical attention.
Glomus Tumor: A rare, benign tumor of the middle ear that can cause pulsatile tinnitus due to its location near major blood vessels.
Venous Hum: An abnormal flow of blood through the jugular vein can cause a humming or pulsing sound in the ear.

Meniere's Disease: A disorder of the inner ear that affects balance and hearing, sometimes causing tinnitus, including pulsing sensations.
Ototoxicity: Certain medications or chemicals can damage the ear, leading to tinnitus, including pulsing in the ears.
Vascular Malformations: Abnormal formations of blood vessels in or around the ear can cause pulsatile tinnitus.
Thyroid Disorders: In some cases, thyroid disorders, particularly hyperthyroidism, can lead to tinnitus, including pulsing sensations in the ears.