A 70-year-old man with a history of diabetes presents with persistent ear pain, purulent otorrhea, and cranial nerve deficits. What could be the potential diagnosis and next steps?
The presentation is suggestive of malignant otitis externa, a severe infection of the ear canal that can spread to surrounding structures. It is seen more often in diabetics or the immunocompromised. Initial evaluation should include imaging such as a CT scan, and cultures from the ear canal. Treatment involves long-term intravenous antibiotics, and potentially surgery if the infection is extensive.