Background: Patent ductus arteriosus (PDA) represents a persistent communication between the descending aorta and pulmonary artery, leading to left-to-right shunt and increased pulmonary blood flow. While most patients present with cardiac murmurs, dyspnea, or heart failure symptoms, otologic manifestations are rarely described. High-output cardiac states resulting from PDA can transmit vascular pulsations to the middle and inner ear, manifesting as pulsatile tinnitus or conductive hearing loss. Recognition of these rare otologic presentations is essential for timely diagnosis and management of the underlying cardiac pathology. Case Report: A 22-year-old female presented with persistent left-sided pulsatile tinnitus and mild conductive hearing loss for six months. Otoscopy revealed an intact tympanic membrane with visible vascular pulsations. Pure tone audiometry confirmed mild low-frequency conductive hearing loss. Temporal bone imaging was unremarkable, but Doppler assessment demonstrated increased middle-ear vascular flow. Cardiovascular examination revealed a continuous murmur at the left upper sternal border. Transthoracic echocardiography identified a 4-mm patent ductus arteriosus with significant left-to-right shunt and elevated cardiac output. The patient underwent successful transcatheter PDA closure. Post-procedure, tinnitus resolved completely within two weeks, and hearing normalized on follow-up audiometry, confirming the causal link between PDA-induced hemodynamic changes and otologic symptoms.