Otalgia is a medical term that refers to ear pain. There are two types of otalgia: primary otalgia and secondary otalgia. Primary otalgia is pain that originates from the ear, while secondary otalgia is pain that originates outside the ear and is referred to the ear. Primary otalgia can be caused by various conditions such as external otitis, otitis media, mastoiditis, and auricular infections. On the other hand, secondary otalgia can be caused by many different pathologies, and the diagnosis can be difficult. Some of the common causes of otalgia include ear infections, too much earwax, airplane pressure, swimmers ear, and dental problems. A comprehensive history and physical examination are vital to evaluate otalgia, and the clinician must consider both primary and secondary causes. Treatment of otalgia depends on the underlying cause, and patients with abnormal vital signs who present initially with otalgia may have a serious infection or traumatic injury.