The most frustrating cases of otitis externa are those that are chronic and recurrent. In order to manage the otitis, certain steps should be taken for a successful outcome. This lecture will focus on the step-by-step management of chronic cases of otitis starting with identification and treatment of any infectious agents present, as well as identification, treatment and control of the primary cause, any predisposing factors, as well as any additional perpetuating factors of the otitis.