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Abstract
Malignant otitis externa is an invasive, potentially life-threatening infection of
the external ear and skull base that requires urgent diagnosis and treatment. It affects
immunocompromised individuals, particularly those who have diabetes. The most common
causative agent remains Pseudomonas aeruginosa. Definitive diagnosis is frequently
elusive, requiring a high index of suspicion, various laboratory and imaging modalities,
and histologic exclusion of malignancy. Long-term oral antipseudomonal agents have
proven effective; however, pseudomonal antibiotic resistance patterns have emerged
and therefore other bacterial and fungal causative agents must be considered. Adjunctive
therapies, such as aggressive debridement and hyperbaric oxygen therapy, are reserved
for extensive or unresponsive cases.