• Uncommon type of otitis externa that is found in immunocompromised individuals (90% cases found in diabetics)
• most commonly caused by Pseudomonas aeruginosa
• Infection commences in the soft tissues of the external auditory meatus, then progresses to involve the soft tissues and into the bony ear canal
• Progresses to temporal bone osteomyelitis

Key features in history

• Diabetes (90%) or immunosuppression (illness or treatment-related)
• Severe, unrelenting, deep-seated otalgia
• Temporal headaches
• Purulent otorrhea
• Possibly dysphagia, hoarseness, and/or facial nerve dysfunction

Diagnosis

• A CT scan is typically done

Treatment

• non-resolving otitis externa with worsening pain should be referred urgently to ENT
• Intravenous antibiotics that cover pseudomonal infections