We examined a 38-year-old male with syringohydromyelia and concomitant symptoms suggestive of intracranial hypertension including unilateral low-frequency sensorineural hearing loss and objective pulsatile tinnitus. The tinnitus was heard by the authors (through a hearing aid stethoscope tube), measured objectively (with a probe microphone), measured subjectively (as minimum masking levels and with fixed frequency Bekesy), and altered by changes in ear canal pressure (subjectively reported and measured objectively with a probe microphone). The audiologic symptoms were likely associated with elevated cerebrospinal fluid pressure that traveled to the cochlea through the cochlear aqueduct. The tinnitus may have originated from pulsations of central vascular structures that traveled through the cochlear aqueduct or the endolymphatic duct. Hearing loss likely resulted from tinnitus masking or a stiffening of the cochlear partition or stapes footplate.