A case is reported of a 57-year-old man with sudden development of nontraumatic left-sided otalgia without any localizing features on otolaryngologic or neurologic examinations. The condition persisted despite empirical antibiotic therapy and simple analgesics. A subsequent computed tomography of the head revealed a subacute left frontoparietal subdural hematoma that was confirmed on magnetic resonance imaging. Neurosurgical drainage was performed with complete symptom resolution. This case report illustrates a possible rare sole presenting manifestation of subdural hematoma. This condition should be considered early in cases of otalgia if no causes are deduced after extensive otolaryngologic evaluation. Copyright 2002, Elsevier Science (USA). All rights reserved.