The recent application of arthroscopic surgical techniques to the temporomandibular joint (TMJ) has facilitated the diagnosis and treatment of TMJ disorders. However, as TMJ arthroscopy is performed more frequently, new complications are being recognized. We report three patients who developed severe otologic complications following TMJ arthroscopy. Two sustained complete or severe sensorineural hearing loss and severe vertigo from trauma to the ipsilateral ear. The third patient had complete facial paralysis from trauma to the facial nerve in the middle ear and a conductive hearing loss from incus dislocation. Complete hearing loss and facial paralysis from trauma to the main trunk of the facial nerve have not been reported previously as complications of TMJ arthroscopy.