Malignant Otitis Externa – A Nonsynchronous Bilateral Case with Transient Multiple Cranial Nerve Palsies

Malignant otitis externa (MOE) is a serious, potentially fatal ear infection that most often affects people with diabetes and typically presents with ear discharge and facial nerve paralysis. It is an infection that causes inflammation and destruction of bone at the skull base. It starts in the external ear and extends locally after the temporal bone becomes infected. Clinically, it presents with severe ear pain and purulent discharge. Imaging plays a key role in confirming the diagnosis and determining the extent of disease. A computed tomography scan is valuable for assessing bone damage, while a magnetic resonance imaging is the preferred method for evaluating soft-tissue involvement and becomes crucial in advanced stages. Management relies on prolonged antibiotic treatment, usually for at least 6 weeks. Generally, it affects one ear; bilateral disease is rare. Here, we report a case of MOE, complicated with meningitis, treated with antibiotics, who later presented with an infection in the contralateral ear, accompanied by lower cranial nerve palsy.