Vascular loop compression is the term used to classify a group of conditions thought to be caused by the compression of cranial nerve by vessel. The vascular abnormality is usually an atherosclerotic aberrant or ectatic intracranial artery, most commonly the anterior and posterior cerebellar artery or the vertebral artery. Hemifacial spasm is a well-recognized clinical feature of vascular compression of the facial nerve. Unilateral auditory symptoms due to eighth nerve involvement with vascular compression have also been reported. Involvement of both seventh and eighth nerves together is a rare condition and imaging features have not been established well. Here, we report a 50-year-old man with hemifacial spasm and unilateral hypoacusia associated with compression of left facial and auditory nerve complex by basilar vascular loop.