KUMJ | VOL. 24 | NO. 2 | ISSUE 95 | APRIL - JUNE, 2026

Malignant Otitis Externa: Contemporary Approach to Diagnosis and Management
Shrestha BL

Abstract:
Malignant otitis externa (MOE), also known as necrotizing otitis externa or skull base osteomyelitis, is an aggressive infection originating in the external auditory canal that can extend to the temporal bone and skull base. It predominantly affects older adults with diabetes mellitus or other immunocompromising conditions. Severe persistent otalgia, particularly nocturnal pain disproportionate to local findings, otorrhea, and granulation tissue in the external auditory canal are important clinical warning signs. Pseudomonas aeruginosa remains the most frequently isolated pathogen, although fungal and multidrug-resistant infections are increasingly recognized. Diagnosis requires a combination of clinical assessment, microbiological evaluation, inflammatory markers, and imaging. High-resolution computed tomography is useful for evaluating bony destruction, whereas magnetic resonance imaging provides superior assessment of soft-tissue, skull-base, intracranial, and cranial nerve involvement. Nuclear medicine imaging and FDG-PET/CT may provide additional information regarding disease activity and treatment response. Prolonged culture-directed antimicrobial therapy, meticulous glycemic control, local ear care, and monitoring of disease activity remain the cornerstones of management. Surgery is reserved for selected indications, including diagnostic biopsy, abscess drainage, sequestrated bone, and refractory disease. Cranial neuropathy, extensive skull-base involvement, poorly controlled diabetes, fungal infection, and delayed diagnosis are associated with poorer outcomes. Early recognition and multidisciplinary management are essential to reduce morbidity and mortality.
Keyword : Cranial neuropathy, Diabetes mellitus, Malignant otitis externa, Necrotizing otitis externa, Skull base osteomyelitis