Surgical management of otitis media and otitis interna includes the following options: lateral bulla osteotomy, ventral bulla osteotomy, or curettage of the tympanic cavity. Because otitis media frequently accompanies chronic nonresponsive otitis externa, one of the above procedures may be combined with operative procedures of the external ear canal. Also, gentle selective curettage of the tympanic cavity may be combined with either lateral or ventral bulla osteotomy in the treatment of otitis media and interna. The choice of surgical procedure(s) should be based on the condition of the external ear canal (vertical and horizontal parts), the duration of clinical signs, response to previous surgery, and the familiarity of the surgeon with the different approaches and techniques. With the increased reporting of long-term results following surgical management of otitis externa, media, and interna, more meaningful conclusions concerning selection of surgical procedure may be made in the future.