Ear pain (otalgia) is a common reason for visits to family physician offices and emergency departments. Otalgia is primary when the pathology originates from the ear, and is secondary for disease processes associated with otalgia and an ear examination with normal findings. The most common diagnosis related to otalgia in children and adults is acute otitis media (AOM). It is characterized by an erythematous, bulging, and cloudy tympanic membrane. Otitis media with effusion is the presence of fluid behind the tympanic membrane without signs of inflammation. Chronic middle ear effusion is managed definitively with myringotomy and tympanostomy tube placement. Tympanic membrane rupture is a common complication after AOM or trauma. Tympanic membranes that do not heal develop chronic infection, leading to chronic suppurative otitis media. Initial management is cleaning and drying of the ear and application of topical antibiotics. Otitis externa is a painful cellulitis of the external auditory canal associated with erythema, edema, and occasional drainage. Cerumen impaction is managed with cerumenolytics, irrigation, or manual extraction. Foreign bodies in the ear are common in children younger than 6 years. Many foreign bodies can be removed with irrigation or forceps.