ZyraDoc #37 - September 07, 2026

A 72-year-old man with a 20-year history of poorly controlled type 2 diabetes presents with excruciating, deep-seated left ear pain and foul-smelling purulent otorrhoea that has worsened over three weeks.

He is treated initially at a local clinic with standard topical ciprofloxacin-dexamethasone ear drops and advice to keep the ear dry.

Despite using the drops, his nocturnal ear pain intensifies, granulation tissue becomes visible at the floor of his external auditory canal, and he suddenly develops an asymmetric smile and inability to close his left eye.

Case Summary

Clinical Focus:

A 72-year-old diabetic male presents with necrotizing otitis externa (malignant otitis externa), a critical Ear, Nose, and Throat (ENT) neuro-otologic emergency that has failed standard topical therapy and progressed to skull base osteomyelitis with facial nerve (cranial nerve VII) involvement.

Diagnostic criteria and red flags for necrotizing otitis externa include:

Severe, unremitting otalgia out of proportion to clinical signs, frequently worsening at night.
Persistent, foul-smelling otorrhoea unresponsive to conventional topical antiseptic or antibiotic drop lines.
Presence of active granulation tissue at the junction of the cartilaginous and bony external auditory canal.
Progression to cranial neuropathies, with the facial nerve being most commonly affected as the infection exits the temporal bone via the stylomastoid foramen.

When necrotizing otitis externa is suspected or complicated by early cranial nerve deficits, immediate hospital admission, high-resolution imaging, and long-term systemic antipseudomonal therapy are mandatory.

Here is the Management Strategy:

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