Papilloma of the middle ear is extremely rare; to our knowledge there have been only 9 reports (13 cases) in the literature. Aggressive surgical excision is the only curative treatment and radiation therapy is necessary if there is evidence of focal squamous cell carcinoma. We describe a case of a 65-year-old male with inverted papilloma of the middle ear. The tumor was surgically resected by radical tympanomastoidectomy, and we provided postoperative radiation therapy. There has been no evidence of recurrence to date. We discuss the clinical presentation, diagnosis, and treatment of this case and present a review of the literature.