OBJECTIVE This study aimed to analyze the etiologies, clinical presentation, treatment options, and results of treatment in a series of patients with acquired external auditory canal atresia (AEACA) and to put this analysis in the context of the existing literature on this topic. METHODS The study design was a retrospective case review. METHODS The study was performed at a tertiary otologic referral practice. METHODS This study included patients with soft tissue AEACA. METHODS Patients received surgical excision of atresia process, conchomeatoplasty, canalplasty, and, when indicated, split-thickness skin graft (STSG) reconstruction. METHODS These included definition of a characteristic patient profile and the incidence of postoperative complications including restenosis. RESULTS This series of six patients is unusual in that in all patients, atresia resulted either from prior surgery or trauma rather than from chronic infection, which is the most commonly seen etiology in the literature. An average of 14 years' lag time transpired between the inciting event and the surgical repair. Five of six patients required STSG for reconstruction; all did well. The single patient who did not require STSG had a minor restenosis develop that did not require revision surgery. CONCLUSIONS Acquired external auditory canal atresia often is caused by trauma or prior surgery. Years may elapse between the inciting event and reconstructive surgery. The use of an STSG can be an important component to a successful surgical outcome.