The temporal bone appears to be affected by metastatic tumors in rather characteristic clinical presentations. More effective cancer treatments have interrupted the course of the disease, allowing more time for metastatic spread. This has increased the importance of prompt diagnosis in a group of diseases that may mimic external auditory canal or middle ear infections. In this paper, we review the distinctive patterns of involvement and presentation of metastatic tumors of the temporal bone, with emphasis on measures that should be taken to ensure early diagnosis.