Malignant Otitis ExternaSymptoms, Doctors, Treatments, Advances & More
Learn About Malignant Otitis Externa
Malignant otitis externa is a disorder that involves infection and damage of the bones of the ear canal and at the base of the skull.
Osteomyelitis of the skull; Otitis externa - malignant; Skull-base osteomyelitis; Necrotizing external otitis
Malignant otitis externa is caused by the spread of an outer ear infection (otitis externa), also called swimmer's ear. It is not common. It is also not a cancerous condition, even though it is called "malignant."
Risks for this condition include:
- Chemotherapy
- Diabetes
- Weakened immune system
External otitis is often caused by bacteria that are hard to treat, such as pseudomonas. The infection spreads from the floor of the ear canal to the nearby tissues and into the bones at the base of the skull. The infection and swelling may damage or destroy the bones. The infection may affect the cranial nerves, brain, or other parts of the body if it continues to spread.
Symptoms include:
- Ongoing drainage from the ear that is yellow or green and smells bad.
- Ear pain deep inside the ear. The pain may get worse when you move your head.
- Hearing loss.
- Itching of the ear or ear canal.
- Fever.
- Trouble swallowing.
- Weakness in the muscles of the face.
The goal of treatment is to cure the infection. Treatment often lasts for several months, because it is difficult to treat the bacteria and reach an infection in bone tissue.
You will need to take antibiotic medicines for a long period of time. The medicines may be given through a vein (intravenously), or by mouth. Antibiotics should be continued until scans or other tests show the inflammation has gone down.
Dead or infected tissue may need to be removed from the ear canal, using a procedure called debridement. In some cases, surgery may be needed to remove dead or damaged tissue in the skull.
Swedish Otolaryngology Specialists - Ballard
Dr. Sachin Gupta is the Director of the Swedish Cochlear Implant Program, and Director of the Swedish Acoustic Neuroma Program. Dr. Gupta is a board-certified Neurotologist, who specializes in treatment of disorders of the ear and skull base. His particular interests include minimally invasive endoscopic ear surgery, cochlear implantation, and vestibular schwannoma (“acoustic neuroma”) surgery. Prior to joining Swedish, he had the privilege of serving as the Director of Otology and Neurotology at Walter Reed National Military Medical Center, followed by several years as an academic Neurotologist at Oregon & Health Science University. Dr. Gupta takes the time to understand each patient's goals to form an individualized treatment plan. He frequently collaborates with providers from Audiology, Neurosurgery, and Head & Neck Surgery, and actively communicates with referring providers to ensure everyone stays on the same page. Dr. Gupta is rated as an Experienced provider by MediFind in the treatment of Malignant Otitis Externa. He is also highly rated in 8 other conditions, according to our data. His clinical expertise encompasses Infant Hearing Loss, DFNB1, Jones Syndrome, Acoustic Neuroma, and Tissue Biopsy. Dr. Gupta is board certified in American Board Of Otolaryngology - Head And Neck Surgery. Dr. Gupta is currently accepting new patients.
Swedish Otolaryngology Specialists - First Hill
Caring is the foundation for excellence. My role as a physician and surgeon is to place the interest of the patient above all else. Listen carefully to my patients and learn, explain options clearly, deliver expert treatment. Dr. Yang is rated as an Experienced provider by MediFind in the treatment of Malignant Otitis Externa. His clinical expertise encompasses Low Nasal Bridge, Nasal Septal Hematoma, Perichondritis, and Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Dr. Yang is board certified in American Board Of Otolaryngology - Head And Neck Surgery. Dr. Yang is currently accepting new patients.
Pacific Medical Centers Specialty Care - Canyon Park
I stress the importance of listening to my patients and encourage a dialogue regarding the potential treatment alternatives. My pronouns are: He/Him/His. Dr. Lamperti is rated as an Experienced provider by MediFind in the treatment of Malignant Otitis Externa. His clinical expertise encompasses Nonallergic Rhinopathy, Palatal Myoclonus, Ozena, and Nasal Polyps. Dr. Lamperti is board certified in American Board Of Otolaryngology - Head And Neck Surgery and American Board Of Facial Plastic And Reconstructive Surgery. Dr. Lamperti is currently accepting new patients.
Malignant otitis externa most often responds to long-term treatment, especially if treated early. It may return in the future. Severe cases may be deadly.
Complications may include:
- Damage to the cranial nerves, skull, or brain
- Return of infection, even after treatment
- Spread of infection to the brain or other parts of the body
Contact your provider if:
- You develop symptoms of malignant otitis externa.
- Symptoms continue despite treatment.
- You develop new symptoms.
Go to the emergency room or call the local emergency number (such as 911) if you have:
- Convulsions
- Decreased consciousness
- Severe confusion
- Facial weakness, loss of voice, or difficulty swallowing associated with ear pain or drainage
To prevent an external ear infection:
- Dry the ear thoroughly after it gets wet.
- Avoid swimming in polluted water.
- Protect the ear canal with cotton or lamb's wool while applying hair spray or hair dye (if you are prone to getting external ear infections).
- After swimming, place 1 or 2 drops of a mixture of 50% alcohol and 50% vinegar in each ear to help dry the ear and prevent infection.
- Maintain good blood sugar (glucose) control if you have diabetes.
Treat acute otitis externa completely. Do not stop treatment sooner than your provider recommends. Following your provider's plan and finishing treatment will lower your risk of malignant otitis externa.
Published Date: April 29, 2026
Published By: Ashutosh Kacker, MD, FACS, Professor of Clinical Otolaryngology, Weill Cornell Medical College, and Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Araos R, D'Agata E. Pseudomonas aeruginosa and other pseudomonas species. In: Blaser MJ, Cohen JI, Holland SM, et al, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 10th ed. Philadelphia, PA: Elsevier; 2026:chap 224.
Quimby AE, Ruckenstein MJ. Infections of the external ear. In: Francis HW, Haughey BH, Hillel AT, et al, eds. Cummings Otolaryngology. 8th ed. Philadelphia, PA: Elsevier; 2026:chap 137.