Otalgia is a common symptom in the pediatric age group. The most common cause is acute otitis media, followed by otitis externa. In the majority of cases, the diagnosis can be established by a thorough history and a careful otologic examination. When the otologic findings are normal and the etiology is obscure, a thorough work-up to determine the source of referred pain is essential. Laboratory investigations are usually not necessary. Treatment should always be directed at the underlying cause.