In pulsatile tinnitus, the differential diagnosis includes neurovascular pathology, which can be occult on non-invasive imaging techniques. Therefore, if a clear diagnosis is lacking, digital subtraction angiography (DSA) is indicated to rule out a potentially hazardous vascular lesion, particularly a dural arteriovenous fistula (dAVF). However, a DSA carries a procedural risk of 1-2%. In a tertiary care setting, the incidence of a dAVF in pulsatile tinnitus patients lacking a diagnosis after non-invasive imaging is about 25-35%. Therefore, the majority of this group of patients is unnecessarily exposed to the risks of DSA. We report on 20 consecutive patients in a tertiary care setting with pulsatile tinnitus who were referred for DSA to rule out neurovascular pathology. We found that the absence of a pulsatile sound detected by transcanal sound recordings, excludes a dAVF (100% sensitivity). Consequently, the use of transcanal sound recordings as a screening tool may prevent patients for the unnecessary risks of DSA in the diagnostic work-up of pulsatile tinnitus. Conventional peri-auriculair and neck auscultation with stethoscope is not always sufficient to objectify the presence of a pulsatile tinnitus. This article is protected by copyright. All rights reserved.