Middle ear inflation procedures are widely used for diagnosis and treatment of middle ear disease. Although its values are controversial, it is used in testing eustachian tube function or treating middle ear diseases, such as effusions or atelectasis. Physicians rarely experience complications with this procedure; thus, complications following middle ear inflation are rare. Known adverse effects of middle ear inflation procedures include pneumocele, brain hematoma, and air embolization. Pneumocephalus is one of the rare complications of middle ear inflation. It is a potentially fatal condition, and although middle ear inflation is used around the world, it is rarely encountered by general physicians and even otolaryngologists. We report a case of pneumocephalus that occurred immediately following a middle ear inflation procedure using a pneumatic otoscope with myringotomy (paracentesis).