Squamous cell carcinoma of the ear masquerading as malignant otitis externa.

While both acute and chronic otitis externa represent conditions that are encountered commonly by primary care physicians, malignant otitis externa can be a diagnostic and therapeutic challenge to generalists and subspecialists alike. Malignant otitis eXterna is a devastating infection of the external auditory canal, which begins as a pseudomonas dermatitis but can progress to an invasive vasculitis and osteomyelitis of the base of the skull. The disease is associated with numerous complications and requires extensive treatment. "Whereas the severity of the external otitis infection can range from acute to chronic to malignant, the possibility of other disease, including carcinoma, must be considered when evaluating unresolving external otitis. Squamous cell carcinoma has many of the same symptoms as malignant otitis externa, and the persistence of symptoms after antibiotic treatment should provoke further investigation to rule out the possibility of an underlying neoplastic lesion. The following case presentation illustrates the need for careful evaluation and follow-up in patients who have apparent malignant otitis externa.