Cholesteatoma of the EAC is a rare otologic problem, particularly when keratosis obturans otica is excluded. The predominant features of EAC cholesteatoma are acute external symptoms, severe pain, recurrent physician visits, and paucity of X-ray findings. Poorly responding otitis externa should always alert the physician to the possibility of neoplasm, diabetes, or some other underlying condition which will not respond to just topical treatment. Cholesteatoma of the external auditory canal should also be considered in refractory cases of otitis externa. Three patients with EAC subperiosteal cholesteatoma are reviewed.