The clinical management and long-term outcome in lightning survivors with subsctantial ear damage treated at the Department of Otorhinolaryngology, University Hospital Split during the 1984–1999 period are reviewed. Results of clinical management and outcomes of lightning ear damage in 18 patients (mean age 35.3 ± 5 years) were retrospectively analyzed. On admission, all patients complained of severe pain, tinnitus and hearing impairment. Otomicroscopy revealed tympanic membrane rupture in 12 patients. The active therapeutic approach included immediate otomicroscopy, aseptic aspiration toilet, and eversion of perforation edges. In all patients, the ruptures healed well, and restitution of the hearing function was achieved. Follow-up examination performed in 1999 (13.2 ± 2.9 years later) in 11 patients (mean age 52.3 ± 6.1 years) revealed an almost identical audiogram as on discharge from the hospital, however, neuropsychological testing revealed numerous sequelae. Tympanic injury caused by lightning should be actively treated. Lightning survivors require additional psychotherapeutic treatment.