Longstanding diffuse otitis externa can lead to irreversible skin changes, canal stenosis, and deafness. Although usually responsive to aggressive medical management, some cases prove refractory. Surgery consisting of a canalplasty and meatoplasty is recommended in these rare instances. The senior author's management of this disease is outlined in detail. Three refractory cases are described, of which two required and responded to surgery with satisfactory hearing and healing. The so-called "malignant external otitis" variety has been excluded from this report.