Diagnosis of the etiology of otalgia can be challenging due to the ear's complex sensory innervation. Primary otalgia is caused by pathologies that originate in the ear itself, also known as otogenic otalgia. It presents with abnormal otologic exams, such as tenderness, edema, and discharge from the ear canal [1,2]. Secondary otalgia can be caused by a wide range of pathologies from outside the ear, such as temporomandibular joint syndrome (TMJ), odontogenic diseases, and cervical spine arthritis [2,3]. This type of ear pain is also known as referred otalgia and is typically transmitted along the nerves that supply both the ear and referring region, specifically cranial nerves V, VII, IX, and X and cervical nerves C2-C3 [[2], [3], [4]].

An MI classically presents with pressure-like retrosternal chest pain, nausea, and arm pain [5]. However, many patients present with atypical symptoms, such as epigastric pain, dyspnea, and craniofacial pain. Craniofacial pain, including otalgia, can present as the sole symptom in up to 6 % of patients with MI [6].

We present a rare case of referred otalgia secondary to MI and a review of the literature. This presentation has rarely been reported in otolaryngology literature and is primarily seen in cardiology journals. We aim to accentuate otalgia as an atypical presentation of MI due to the high mortality associated with delayed diagnosis of this condition.