Humoral adenosine 5′-triphosphate (ATP), adenosine and uridine 5′-triphosphate (UTP) have been shown to have a role in controlling local blood flow in a variety of tissues. The presence of P1 and P2 receptors in the cochlea, and particularly the highly vascular region, the stria vascularis, implies a vasoactive role for these compounds in the inner ear. To test the effect of extracellular purines and pyrimidines on cochlear blood flow, cochleae from anaesthetised guinea-pigs were perfused with ATP (1 μM–10 mM), adenosine (1 μM–10 mM) and UTP (1 mM) in artificial perilymph while blood flow through the cochlea was measured. An acute perilymphatic perfusion technique was established via tubing placed through a hole in the bone overlying scala tympani of the first cochlear turn, with an outlet hole in scala vestibuli of the fourth turn. Blood flow was measured by placing the probe of a laser Doppler blood perfusion monitor on the bone overlying the stria vascularis in the third cochlear turn. ATP and adenosine produced a significant dose dependent increase in cochlear blood flow (28.8–229.0% and 35.8–258.1%, respectively). The effect of ATP (100 μM) on cochlear blood flow was reduced in the presence of reactive blue 2 (1 mM) and pyridoxalphosphate-6-azophenyl-2′,4′-disulphonic acid (1 mM). The blood flow response to adenosine (10 μM) was reduced in the presence of 1,3-dimethylxanthine (theophylline, 100 μM), but not with either 3,7-dimethyl-1-propargylxanthine (10 μM) or 8-cyclopentyl-1,3-dipropylxanthine (10 μM). UTP did not produce any change in the cochlear blood flow. To determine if the ATP effect was also mediated by adenosine derived from ectonucleotidase activity, the perilymphatic compartment was perfused with either ATP plus theophylline (100 μM) or with the non-metabolisable form of ATP, adenosine 5′- O-(3-thiophosphate) (ATPγS, 100 μM). The effect of ATP on cochlear blood flow was unaffected with the inclusion of theophylline while ATPγS produced an increase in cochlear blood flow similar to the one observed with ATP. These findings indicate that extracellular ATP and its metabolite adenosine have a modulatory role in cochlear blood flow possibly mediated by both P1 and P2 receptors.