Otologic surgery involves a broad range of procedures. In general, postoperative pain from most otologic surgeries can be managed with little to no opioids, and surgeons should make a concerted effort to minimize narcotic prescriptions in the midst of the opioid crisis. Many procedures, including transcanal surgeries and even postauricular surgeries, may performed with local anesthetic in selected patients. Multimodal pain regimens, local anesthesia, and alternative approaches have shown promise in minimizing narcotic use, and should be considered. Preoperative counseling to appropriately manage expectations and goals is imperative for patient satisfaction and safety.