Purpose <p>This study aims to assess pain management strategies employed by otolaryngology residents for acute otologic conditions, evaluate their perceptions of pain management both generally and specifically for these conditions, and understand the pain management training and education they received during residency.</p> Methods <p>A national, cross-sectional web-based survey was conducted among otolaryngology residents across all training levels. The survey opened with a theoretical patient encounter where participants provided discharge recommendations, unaware that pain management considerations were the primary outcome of interest. Responses were examined for pain management strategies. additional questions assessed residents’ knowledge, attitudes, and practices in managing acute pain in otologic conditions, focusing on identifying gaps in clinical confidence,training and effectiveness.</p> Results <p>42/45 (93%) ENT residents participated. Among respondents (n = 28), acknowledged pain in the discharge note, while (n = 14) did not. For those acknowledging pain (n = 22), advised "as-needed" medications without specification whereas only (n = 5) mentioned specific medications. One participant recommended around-the-clock analgesia. Pain training in residency for acute infectious otologic conditions was rated as sufficient by only (n = 16) of the respondents, with (n = 32) reporting no formal pain management education during residency. Familiarity with analgesic terms was limited, with (n = 21) being completely unfamiliar. A strong need for formal acute pain management training was expressed by (n = 37) of participants.</p> Conclusion <p>There are critical areas for improvement in pain management education and practices among ENT residents. Addressing these gaps through standardized training programs and clearer clinical guidelines can lead to better pain management in patients with acute otologic conditions.</p>