We report the case of a 72-year-old male presenting with a papillary adenocarcinoma of the middle ear. He had had a similar tumour excised from the ipsilateral nasopharynx seven years previously with no evidence of local recurrence. We conclude that this middle ear lesion possibly represents a second tumour. No record of such a case has been reported previously in the literature. We discuss presentation and management and highlight the need for close follow-up of these patients.