Once the clinical diagnosis of MOE was established, treatment was started with oral and topical ciprofloxacin and a computed tomography (CT) scan of the ears and mastoids was requested. The patient reported progressive worsening of the earache and preauricular pain despite analgesic treatment. After a cycle of topical treatment with dexamethasone and gentamicin, repeat otoscope examination revealed a laceration in the floor of the EAC exposing bone tissue, with an inflammatory reaction and abundant otorrhoea. Otoscope examination at that time showed an EAC with oedematous and erythematous walls, with the eardrum intact. The symptoms had begun at least two months before the initial consultation and consisted of earache, hearing loss and otorrhoea from the right ear (RE). His usual treatment consisted of bisoprolol, simvastatin and acetylsalicylic acid. This was a 63-year-old male patient, originally from Ecuador but resident in Spain for over 20 years, whose previous medical history included hypertension, dyslipidaemia, subclinical hypothyroidism and gout. 2–4 We present a case of MOE due to Candida albicans complicated by skull base osteomyelitis in a patient without predisposing factors and we discuss the role of echinocandins in the treatment of this unusual scenario. is well reported in patients with human immunodeficiency virus (HIV) infection or neutropenia, with other fungal aetiologies being rarer. Although over 90% of episodes are caused by Pseudomonas aeruginosa, MOE caused by Aspergillus spp. 1 After originating in the squamous epithelium of the external auditory canal (EAC), MOE can invade adjacent bone structures and lead to life-threatening skull base osteomyelitis. 1 It generally affects older patients with poorly controlled diabetes or immunosuppression. Malignant otitis externa (MOE), also called necrotising otitis externa, is a rare condition in Spain, with the annual incidence recently being estimated at 1.30 cases per million population.
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