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Necrotizing otitis externa (OE) is traditionally seen in elderly diabetics and immunocompromised patients. During a 7-year period at our institution, we treated 6 patients with necrotizing OE who were not diabetic, who were not immunocompromised, and who were relatively young (age range: 27 to 65 yr; mean: 42.8). The necrotizing OE in these patients was less aggressive but just as severe as its usual presentation in older diabetic or immunocompromised patients. All 6 patients had evidence of bony erosion on computed tomography of the temporal bones, although 4 had negative findings on technetium-99m scintigraphy. Four of the 6 patients required mastoid exploration and fascia lata grafting, and the other2 chose to undergo extensive daily microdebridements and intravenous antibiotics followed by 6 weeks of oral antibiotics. We recommend that a diagnosis of necrotizing OE be kept in mind when evaluating any patient who presents with severe otalgia, particularly in the presence of Pseudomonas aeruginosa infection of the external auditory canal, edema, granulation tissue, and bony erosion. [ABSTRACT FROM AUTHOR]

We report the case of a 34-year-old man with pulsatile tinnitus and a reddish mass in the anteroinferior quadrant of the middle ear. Physical examination and imaging were unable to establish a diagnosis, so an exploratory tympanotomy was performed. Exploration revealed the presence of an ectatic aberrant internal carotid artery in the middle ear. Aberrations of the internal carotid artery in the middle ear are rare. Even so, our case is unusual in that all initial investigations had failed to establish the diagnosis. This case highlights the limitations of modern imaging techniques in certain situations. [ABSTRACT FROM AUTHOR]