Osteomas of the middle ear are exceedingly rare benign neoplasms. To date, 16 cases have been reported in the literature, the vast majority of which appear as middle ear masses in young males with a progressive conductive hearing loss. In most patients, the diagnosis is confirmed by computed tomography (CT) or at the time of surgical exploration. Although these lesions have been described as slow-growing, no long-term follow-up has been reported. We present the seventeenth case of a middle ear osteoma in a 33-year-old man who remains asymptomatic and without evidence of tumor growth after nine years of follow-up. We suggest that asymptomatic middle ear osteomas can be appropriately managed without removal in a select group of patients.