Background: Microvascular decompression of cranial nerves began in the 1960’s as a novel approach to treating patients for trigeminal neuralgia. Decompression of other cranial nerves for a variety of other symptoms has followed. Design: We present a case of microvascular decompression for intractable tinnitus and hearing loss. Pre and post-operative Pure Tone Audiometry (PTA) and Tinnitus Handicap Index (THI) were measured as primary outcomes and the patient was followed for one year. Results: Tinnitus severity reduced transiently after decompression, and hearing was preserved. Conclusion: Microvascular decompression of the vestibulocochlear nerve can treat tinnitus, vertigo, and hearing loss in severe cases where other treatments have failed. Patient selection is poorly understood and patient’s expectations must be carefully managed.