Middle ear meningiomas can be confused with other lesions based on their site of origin. Tegmen tympani meningioma can be mistaken for fibrous dysplasia or cholesteatoma, while JF meningioma may resemble glomus jugulare paraganglioma. IAC meningioma may mimic schwannoma. Imaging features such as dural enhancement and preserved internal architecture of involved bone can help distinguish temporal bone meningiomas from other lesions. Patients treated with tumor resection and ossicular prosthesis implantation can expect serviceable hearing after surgery. In some cases, watchful waiting may be the most prudent approach.