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Background and Objective: Otalgia is a complaint triggered from either ear disorders or adjacent structures due to common innervations between ear and adjust organs. This study was done to explore the causes of primary otalgia. Materials and Methods: This descriptive study was done on 770 patients with otalgia in Gorgan, Iran during 2009-10. After clinical examination age, gender, patient complaint and signs were recorded for each patient. Results: 668 patients (86.8%) had primary otalgia including 39.9% left, 41.3% right and 18.8% bilaterally. 63.9% were female and 36.1% were males. External otitis was the most common causes of primary otalgia with 64.8%. Other causes consist of acute otitis media (14.5%), serumen (14.1%), chronic otitis media (5.8%), foreign body (4%) and trauma (3%), respectively. Conclusion: The most common cause of primary otalgia was external otitis.