| Summary: | Skull base lesions are enigmatic and often behave unpredictably. This report is about a case of skull base osteomyelitis as a complication of malignant otitis externa and how one can investigate such skull base lesions early. A 72-year-old known diabetic male patient with a previous history of recurrent otitis externa, presented with symptoms similar to syncopal attack to the emergency room.During a routine ENT consultation, a mass in the nasopharynx was discovered. Immediately,multimodality imaging was requested and it confirmed a soft destructive dense tissue mass in the skull contiguous with the posterior nasopharynx. Trans-nasal biopsy was inconclusive. However, to determine the exact nature of the lesion HRCT Temporal bone and T2 weighted Gadolinium MRI imaging was done. That confirmed our diagnosis of Malignant Otitis Externa. The lesion was controlled by broad spectrum IV antibiotics in the initial 3 weeks followed by oral antibiotics for several weeks to completely eradicate the lesion.
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