Although acute mastoiditis and intracranial otogenic complications occur less frequently in our time than in the preantibiotic period, the disease is nevertheless still a rather severe medical problem. Its mortality rate remains relatively high and the severity of its symptoms is often underrated or misinterpreted by the inexperienced physician. On the basis of some personal clinical observations made during the last decade, attention has been drawn to the most common intracranial and extracranial otogenic complications in adults and children. It may therefore be concluded that otitis media must still be considered a dangerous disease, necessitating fundamental knowledge of its underlying pathology, which provides a basis of early correct diagnosis and adequate intensive therapy.