Atypical Manifestation of Skull Base Osteomyelitis Secondary to Malignant Otitis Externa Following Radiotherapy: A Case Report

Skull base osteomyelitis represents a rare but potentially fatal complication of malignant otitis externa (MOE), predominantly affecting elderly patients with diabetes or immunosuppression, and may also occur in individuals with a history of head and neck radiotherapy. We report the case of a 79-year-old female with poorly controlled diabetes and a remote history of undifferentiated carcinoma of the nasopharynx (UCNT) treated with radiotherapy 17 years prior, who neglected chronic, fluctuating otalgia. She presented with massive left-sided otorrhagia complicated by hemorrhagic shock and a left peripheral facial palsy graded House-Brackmann IV. High-resolution imaging demonstrated extensive destruction of the temporal bone and skull base, and microbiological cultures identified <i>Pseudomonas aeruginosa</i>. Prompt, prolonged targeted antibiotics led to complete clinical recovery. This case underscores the critical importance of early recognition, meticulous longitudinal follow-up of post-radiotherapy patients, and aggressive multidisciplinary management to prevent potentially life-threatening complications. The unusual presentation of this case makes it worthy of sharing.