Objectives: The objective of this study is to determine the possible associations between acute otitis media (AOM) and shisha smoking, cigarette smoking, and vaping in adults. Materials and Methods: The study was carried out from August 2019 to April 2020 using a case-control design. The sample consisted of 144 male participants from King Saud University Medical City aged 18–55 years, of whom 72 were cases, i. e., diagnosed by a physician with AOM, and 72 were controls, i.e. diagnosed with a physical injury with no history of AOM. The participants were interviewed over the phone based on a validated questionnaire by the WHO and were evaluated for shisha smoking, cigarettes smoking, and vaping status. Results: Of the 144 patients originally contacted, 136 (67 cases and 69 controls) were included in the analysis. The total number of participants who smoked any type of tobacco was 51 (37.5%). Among the 51 general smokers, 54.9% had a history of AOM with odds ratio of 1.436 (confidence interval [CI] 0.715–2.884, P = 0.308). Among shisha smokers, 70% developed AOM with odds ratio of 2.774 (CI 0.996–7.721, P = 0.045). Among cigarette smokers, 53.6% had a history of AOM with odds ratio of 1.287 (CI 0.617–2.681, P = 0.501). The number of vape users was too low to produce any significant results. Conclusion: The study found a significant association between shisha smoking and AOM among adult men in Riyadh. This finding correlates with what previous studies found about the dangers of tobacco consumption.