A 55-year-old diabetic man presents with left ear pain disproportionate to local findings, granulation tissue at the bony cartilaginous junction of the external auditory canal, and ESR of 110 mm/hr. Culture grows Pseudomonas aeruginosa. CT shows bony erosion of the temporal bone. What is the most dangerous potential complication of this condition?

• A Sensorineural hearing loss
• B Facial nerve palsy
• C Meningitis
• D Skull base osteomyelitis with sigmoid sinus thrombosis ✓

Explanation

This is malignant (necrotising) otitis externa, most common in elderly diabetics and immunocompromised patients, caused by Pseudomonas aeruginosa. The infection erodes through the tympanomastoid suture and along the skull base, causing skull base osteomyelitis. Progression to involve the sigmoid sinus (thrombosis) and jugular foramen is life-threatening, carrying significant mortality. Facial nerve palsy is a common morbidity but skull base osteomyelitis with vascular involvement is the most dangerous complication.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.