Skull base osteomyelitis secondary to malignant otitis externa

Skull base osteomyelitis secondary to malignant otitis externa was first described in 1959. Since then, advances have been made in the diagnosis, treatment, and clinical outcomes of this condition. This review discusses the pathophysiology and microbiology of malignant otitis externa. The review highlights the sometimes subtle presenting symptoms and recent advances in imaging and their practical application to diagnosing and monitoring the disease. Therapy for malignant otitis externa has changed since this entity was first described; this article reviews the medical, surgical, and adjuvant therapies and the relevant controversies. The review discusses the history, pathogenesis, diagnosis, and treatment of skull base osteomyelitis in the context of malignant otitis externa with particular emphasis on HIV, children, and other immunodeficient states.