Acute otitis media is one of the most common diagnoses made in children in the United States. Intracranial and extracranial (intratemporal) complications have greatly decreased in the antibiotic era, but still remain a challenge when they arise. This article addresses two intratemporal complications with significant associated morbidity: facial nerve paralysis/paresis, and labyrinthitis. Epidemiology, pathology, clinical diagnosis, and treatment options are discussed, focusing on an evidence-based approach to diagnosis and management. In addition, the future of treatment and current questions regarding otitis media are briefly discussed.