Malignant otitis externa (MOE) is an uncommon infective but potentially fat
al entity caused by Pseudomonas aeruginosa. It involves almost exclusively
advanced aged diabetic patients. We report here four cases diagnosed at our
hospital during the last 7 years. Clinical manifestations included otalgia
, purulent otorrhoea; involvement of different cranial nerves and bony dest
ruction; one patient died because of bronchoaspiration and two are alive bu
t with sequelae. MOE should be suspected in every diabetic patient with oti
tis which goes unresolved with the usual antibiotic therapy. On the other h
and, facial palsy should not always be attributed to a diabetic mononeuropa
thy and the presence of MOE should be ruled out when otitis coexists or pre
cedes it.