Pulsatile tinnitus arising from an aberrant internal carotid artery at the level of the nasopharynx is rarely found. We present a case of a 74-year-old woman complaining of pulsatile tinnitus in the right ear. The tinnitus was not audible by auscultation. Endoscopic examination revealed pulsating swelling of the nasopharyngeal wall on the right side. Computed tomography angiography of the head and neck region showed medial and superficial transposition of the right internal carotid artery at the level of the nasopharynx. The artery was located right next to the orifice of the Eustachian tube and coursed along the distal portion of the tube. The patient's perception of tinnitus was improved after explaining the cause of the tinnitus and reassuring her about thecondition.