AIM To describe that External Auditory Canal Cholesteatoma (EACC) can evolve from long standing cases of Keratosis Obturans (KO). MATERIALS AND METHODS Total of 5 patients was examined and clinically diagnosed to have keratosis obturans. Three patients out of this had previous history of keratosis obturans in the EAC which was removed 2 years back in our hospital. All the patients were posted for removal of keratosis obturans under general anaesthesia. The removed specimen was sent for histopathological examination. RESULTS The five patients had whitish debris filling the external auditory canal in the background of inflammation. In all the cases there was widening of external auditory canal with inflammation. In two cases there was erosion of bony external auditory canal. CONCLUSIONS The clinical picture of EACC and KO is overlapping to a certain extent, but KO is more common than EACC. EACC is usually seen to arise in long term and neglected cases of KO.