OBJECTIVE: Present experience in diagnosis and treatment for referred otalgia secondary to cervical spine degenerative disease (CSDD). STUDY DESIGN: A retrospective study of 123 patients with ear pain. SUBJECTS AND METHODS: All patients had a normal otologic examination and diagnosed with unspecified otalgia. The causes for referred otalgia were categorized into Group I: otalgia from non-cervical spine disease (n = 72), and Group II: cervical spine disease-referred otalgia (n = 51). Pain relief following cervical spine physical therapy (CSPT) was assessed. RESULTS: The most common cause for referred otalgia in Group I was Temporomandibular joint (TMJ) dysfunction (46%); most common cervical spine finding in Group II was CSDD (88%). CSPT in those documented patients all reported subjective pain relief. CONCLUSION: As the population in America ages, CSDD in the elderly will begin to emerge as a major etiologic source for referred otalgia. With a targeted medical history and physical examination one can use directed studies to diagnose CSDD-referred otalgia, and this pain can be alleviated with CSPT.