An 80-year-old man was seen in the clinic with a two month history of pain, bleeding and deafness in his left ear; accompanied by a left facial palsy. Six months earlier, anaplastic carcinoma of the bladder had been diagnosed and treated with radiotherapy. On examination there was a mass in his left external auditory canal and VII, VIII, IX and X left cranial nerve palsies. Histology of a biopsy was identical with his original bladder tumour. He received a course of palliative radiotherapy but died shortly after. Post-mortem demonstrated the left temporal bone metastasis extending into the middle and posterior cranial fossae. There was no evidence of residual bladder tumour, or other primary tumour. Temporal bone metastases are probably more common than generally thought. Presentations like this may become more common as cancer therapy improves, with patients surviving longer and presenting later with metastatic disease.