Neuroendocrine tumours (NETs) represent a spectrum of tumours with a diverse range of molecular abnormalities, functionality and anatomical locations. 1 The common sites of neuroendocrine tumours include the gastrointestinal tract, pancreas and lungs, although other primary sites have been reported, such as the ovary, 2 thymus and C cells of the thyroid. 3 Very rarely, these tumours appear to arise from the middle ear and, although extremely uncommon, accounting for < 2% of all middle ear tumours, 4 they are important to differentiate from other middle ear tumours because the management of these tumours significantly differs from these other types of tumour. In addition, they raise significant questions as to the provenance of such tumours arising from an area not generally known to harbour neuroendocrine tissue.We describe two patients with middle ear NETs, one with multiple local recurrences and the other with distant metastases, discuss the management of these tumours, and review the extant literature on these tumours and their putative derivation.