This chapter addresses the evaluation and management of acute earache. Both primary and secondary otalgia are defined. The chapter outlines the specific history and examination of a patient who presents with acute earache with appropriate illustrations. Important points in history and examination of these patients are highlighted in boxes. Differential diagnosis of common causes for earache is also listed in boxes. Specific tests for diagnosis of different causes of earache are described. Imaging findings in some of these patients is described with illustrations. Simple methods of treating some conditions causing acute earache in the Emergency room have been described with clinical pictures. The need for surgical intervention in some situations is also described. A box describing the do’s and don’ts of management of these patients is also provided for ready reference. There are two videos: one showing a foreign body in the deep ear canal and the other showing the removal of a glass bead from the ear of a child.