ABSTRACT
This chapter presents a case study of a 78-year-old diabetic gentleman who is presented with severe right-sided otalgia. He also complains of purulent otorrhoea, hearing loss, vertigo and tinnitus. This patient has malignant otitis externa (MOE), also known as necrotising otitis externa. MOE is associated with diabetes, immunosuppression and haematological malignancies. The defining features of MOE are severe otalgia, often exceeding oral analgesics, in the older diabetic patient. Other symptoms such as hearing loss, otorrhoea, vertigo and tinnitus may also be present or neurological signs if there are any intracranial complications. Otosocopic examination may demonstrate granulation tissue on the osteocartilaginous junction, which is pathognomonic. Palpation of tragus or pinna traction produces severe pain. The patient may have facial cellulitis around the ear. A full cranial nerve neurological examination especially nerves VII (stylomastoid foramen) and IX-XI (jugular foramen) is essential.
