Malignant external otitis represents a severe, progressive Pseudomonas infection. Although it begins locally in the external auditory canal, it may invade soft tissues and bone and lead to parotitis, mastoiditis, cranial nerve palsies, meningitis, and death. Elderly diabetics appear most vulnerable, but it is thought that any impairment of host resistance may predispose to this disease. Early diagnosis with prompt administration of antibiotics and surgical intervention can prove lifesaving.