Africa has the highest global otitis media (OM) burden; however, regional trends and projections remain underexplored. We assessed the OM burden (incidence, prevalence, mortality, and disability-adjusted life years [DALYs]) across Africa (1992–2021) and forecasted 2037 trends. Data for this study were extracted from the Global Burden of Disease (GBD) database 1992 to 2021 and were analyzed using joinpoint regression, age-period-cohort (APC) analysis, decomposition analysis and Auto Regressive Integrated Moving Average (ARIMA) projections. Africa’s age-standardized incidence rate (ASIR) slightly increased (+0.02% average annual percentage change, AAPC), while the prevalence (−0.18%), mortality (−2.73%), and DALY rates (−0.39%) declined. In 2021, Eastern Africa had the highest ASIR/ age-standardized mortality rate (ASMR); Central Africa had the highest age-standardized prevalence rate (ASPR)/age-standardized DALY rate (ASDR). Children aged <9 years bore the greatest burden. The APC analysis shows that age and period were correlated with incidence rate. Decomposition analysis showed that population growth positively drove increases in disease burden, while aging negatively affected the growth. Projections estimate that ASIR will rise to 6,019.27 per 100,000 by 2037, while ASPR and ASDR will decline to 1,730.65 and 34.11 per 100,000. Reducing OM's disease burden necessitates strategies better aligned with African population needs and global collaboration.