Intrapetrous Internal Carotid Artery Pseudoaneurysm Secondary to Malignant Otitis Externa: A Case Report

Malignant otitis externa (MOE) can rarely progress to skull base osteomyelitis (SBO) with catastrophic vascular complications. We describe a 68-year-old man with uncontrolled diabetes (HbA1c 9%) who presented with left otalgia, purulent otorrhea, and hearing loss. Initial workup showed CRP 23 mg/L, leukocytes 8,000/µL, and ear pus culture positive for Pseudomonas aeruginosa....

Audiologists and ENT-adjacent clinicians should be aware that malignant otitis externa — especially in diabetic or immunocompromised patients — can rarely progress to catastrophic vascular complications such as intrapetrous carotid pseudoaneurysm; prompt escalation and imaging are critical when patients fail to improve.

This case underscores the potentially fatal vascular sequelae of malignant otitis externa, reinforcing the need for vigilant follow-up and low threshold for advanced imaging in high-risk patients presenting to audiology or ENT settings.

1. 01Rare case: malignant otitis externa (aggressive outer ear infection) led to a pseudoaneurysm of the internal carotid artery inside the skull.
2. 02Patient was a 68-year-old man with diabetes — a key risk factor for malignant otitis externa.
3. 03Skull base osteomyelitis (bone infection at the base of the skull) was also present as part of disease progression.
4. 04Intrapetrous carotid pseudoaneurysm is a life-threatening complication requiring urgent vascular intervention.
5. 05Case highlights that severe or non-resolving otitis externa in immunocompromised patients warrants urgent multidisciplinary evaluation.

PMID

42388916

DOI

10.7759/cureus.110046.

Journal

Cureus

Publication type

case_report

Evidence level

4

Sample size

1

Population

68-year-old diabetic male with malignant otitis externa and skull base osteomyelitis

Intervention

Diagnosis and management of intrapetrous internal carotid artery pseudoaneurysm secondary to malignant otitis externa