This chapter summarizes the acute complications of acute and chronic otitis media. The various extracranial and intracranial complications of otitis media are classified and tabulated. They include extracranial complications like mastoid abscess, labyrinthitis and facial palsy as well as intracranial complications like meningitis, brain abscess and lateral sinus thrombosis. The reader is introduced to the general symptoms and signs suggestive of otogenic complications of otitis media as well as the specific clinical features of each complication. The importance of radiology and its timing in the diagnosis of complications in the antibiotic era is highlighted. Radiological images of several intracranial complications have been provided. A flow chart showing a suggested protocol for evaluation of a patient with suspected intracranial complications of otitis media has been provided for quick reference. The medical and surgical managements of these complications are also described in detail.