Learning Objectives: To highlight the role of surgery in the management of malignant (necrotising) otitis externa.

Introduction: Malignant (Necrotising) Otitis Externa (MOE) was first described in 1959 as a pseudomonal osteomyelitis of the temporal bone in an elderly diabetic. Subsequent single case reports appeared in the literature. It was said to be an extremely rare condition. Although a number of early publications reported surgical intervention, the prognosis was very poor and the mortality high. By the time the senior author was in training, the standard teaching was that surgery had no role to play in the management of MOE.

Over the past 20 years our experience has been that the incidence of MOE has increased dramatically. The role of fungul infection in conjuction with pseudomonas may make successful treatment more difficult.

In a small but significant number of our patients surgery has been used as an adjunct to medical therapy.

Methods: We report a series of 4 patients with MOE who all had tympanomastoid surgery as part of their treatment. All had had uncontrolled pain and In two cases facial palsy was an indication. In one the palsy had been present for over three months.

Results: Following surgery all four patients had significant and rapid control of their pain. The two patients who had had facial palsies both recovered, one completely and rapidly and the other to a House-Brackmann grade II after 9 months.

Conclusions: We are seeing far more patients with MOE than ever before. We postulate why this might be.

While aggressive medical therapy is vital, surgery should be considered in the management of patients with MOE when the symptoms and clinical signs are progressing despite adequate medical treatment. Facial palsy should be considered as an indication for early surgery in MOE just as it would be in other inflammatory diseases of the temporal bone.