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Our objective is to heighten the awareness of the clinician to the unusual features of latrogenic, pulsatile, yet nonvascular tinnitus. We present the case of an elderly white male with pulsatile tinnitus immediately following microvascular trigeminal decompression. Computed tomography revealed an extradural air collection and mastoidal fistula. The patient noticed resolution of tinnius with digital pressure over the mastoidal operative site. Treatment included exposure of the aerocele with resection of the lateral wall, fistula obliteration with wax, and abdominal fat graft. The patient noted complete resolution of his tinnitus in the recovery room. The etiology of pulsatile tinnitus can be suspected based on history and can be confirmed with corroborative imaging techniques.