The temporal bone often falls within the field of radiation for head and neck tumors. Whereas osteoradionecrosis is well recognized as the end-stage complication of radiation to the temporal bone, serious non-osteitic complications can also occur, and these are important because the ear is an organ of special sense. Radiation causes changes in the specialized tissues of the ear that can impair function and influence therapeutic decisions. The purpose of this article is to review the non-osteitic effects of radiation on the ear. A series of cases is presented that illustrate the spectrum of non-osteitic complications of radiation therapy. External canal stenosis, otitis media with effusion, chronic suppurative otitis media with or without cholesteatoma, sensorineural hearing loss, vestibular impairment, and facial nerve paralysis are described. Management should be guided by an understanding of the pathogenesis of these complications. The authors believe that non-osteitic complications of therapeutic radiation to the temporal bone are relatively common and warrant increased recognition.