Oral submucous fibrosis (OSMF) is a chronic and progressive disease where fibrous bands formed in the oral mucosa, resulting in severe restriction of movements of the jaw and also tongue. OSMF is one of the commonly seen potentially malignant disorders which can cause severe morbidity. It is prevalent in the Indian subcontinent. The exact etiology of OSMF is not known. Chronic irritation of the oral mucosa is thought to be the underlying etiology for OSMF. The common irritants are betel nut, tobacco, and chilies. The pathological changes not only affect mucosa and submucosa of the oral cavity and pharynx but also affect deeper parts with the involvement of underlying muscles. Atrophic and degenerative changes in the tubal and paratubal muscles of the eustachian tube, leading to eustachian tube dysfunctions. The eustachian tube dysfunction in OSMF results in different otological symptoms such as hearing impairment, otalgia, and fullness in the ear. Dysfunction of the eustachian tube in OSMF may be due to fibrosis in the palatal muscles, resulting in a conductive type of hearing loss. While treating OSMF, otological manifestations such as eustachian tube dysfunctions and hearing impairment have to be kept in mind and vice versa because managing hearing disability without taking care of OSMF will not be successful. All literature related to otological manifestations in OSMF were identified through Scopus, Google Scholar, Medline, and Pub Med and analyzed individually. This review article discusses the etiopathology, epidemiology, clinical manifestations, and management of the OSMF with otological manifestations.