The clinical picture and the treatment of acute otitis media (AOM) and its complications have changed during the past decades. The availability of antibiotics has decreased the incidence of complications of AOM significantly. The treatment of complications of AOM is conservative in most cases. Mastoidectomy is needed when abscess-forming mastoiditis or intracranial complications develop. Although intratemporal and intracranial complications of AOM are rare today, they still cause morbidity, and need prompt treatment. Occasionally, permanent damage of the ear leads to hearing loss, vertigo, and sometimes, facial weakness. Antibiotic treatment has decreased the mortality associated with the complications of AOM, but it is still high in countries with developing health care systems. Early diagnosis and effective treatment of the complications are the bases for a good prognosis.