The bacterial cause of external otitis was first identified during World War II, and our understanding of this condition and its management has been relatively static until recently. The use of fluoroquinolones to treat pseudomonas infections has focused attention on topical therapy for external otitis and single-drug oral therapy for skull-base osteomyelitis, which arises as a complication of external otitis. This article reviews the pathophysiology of external otitis, outlines management options with special attention to topical therapy, and presents management options for skull-base osteomyelitis.