Abstract Objective To examine neurotologists' 2013 to 2016 Medicare Part‐D data and evaluate commonly prescribed medications, longitudinal changes in prescribing patterns, presumed associated pathologies, and cost distribution across United States. Methods Comprehensive prescription data of Part‐D‐participating neurotologists was quiered from the 2013 to 2016 Medicare Part‐D database. Outcome variables consisted of the 25 most commonly prescribed + refilled medications, cost distribution per medication, presumed associated pathologies, and standardized prescription cost across United States. Results Of the 594 available U.S. neurotologists, 336 (57%) were found in the Medicare Part‐D database. In 2016, total prescription costs were $4 483 268 with an averaged $13 343 ± $18 698 per neurotologist. The three most frequently filled drugs were fluticasone propionate, ciprofloxacin, and triamterene‐hydrochlorothiazide. From 2013 to 2016, the greatest change in prescription pattern was observed with azelastine (+188%), montelukast sodium (+104%), mupirocin (+63%), and mometasone (−91%), whereas the greatest change in relative drug cost distribution was seen in ofloxacin, (+695.7%) neomycin‐polymyxin‐hydrocortisone (+262.1%), and mometasone (−83%). Triamterene‐hydrochlorothiazide, prednisone, montelukast, amoxicillin‐clavulanate, azelastine, spironolactone, and mupirocin had statistically significant increases in average number of prescriptions per physician, whereas ofloxacin and mometasone had significant decreases. Medications presumably treating Eustachian tube dysfunction, Meniere's disease, and vestibular migraine had the greatest percent changes across years. Cost distribution of four drugs increased upwards of 100%. Geographic analysis demonstrated that Southern and Midwest regions had higher standardized prescription costs. Conclusions This study is the first to analyze neurotologists' trends in prescribing patterns, regional prescription cost distributions, and commonly treated pathologies. This can lead to better standardization of prescribing patterns and cost in the future.