It was created first in 1542 for The O'Neill Mór, King of Tir Eoghan, Conn Bacach O'Neill, who submitted to the English king Henry VIII and was rewarded with the title of Earl with the subsidiary title of Baron of Dungannon. A writ for Conn's son Shane O'Neill was signed by Queen Elizabeth and he is considered by some to have been the second earl. However, he went into rebellion and was killed before the title could be conferred. The title was forfeited in 1608 by his grandson, the third earl: Hugh, after the Flight of the Earls. The English-Irish version went into abeyance in 1616 when Hugh died in Rome. The O'Neill version of the title then became a Spanish creation, due to their lengthy participation in the armies of the Netherlands, Portugal, and Spain.
The English title was created again in 1673 for Lord Power, but became extinct upon the death of the third earl in 1704. It was created a final time in 1746 for Marcus Beresford, 1st Earl of Tyrone Marcus Beresford, son-in-law of the last Power earl. His son was created Marquess of Waterford in 1789, and the title has since been a subsidiary title of the Waterford title.
The title Count of Tyrone was also created for the O'Neill family. It started as a Spanish Netherlands creation in 1621 when Patrick O'Neill, the second son of Sean O'Neill (eldest son of Earl Hugh O'Neill) was granted this courtesy title by Infanta Isabella of the Spanish Netherlands.