A 70 year old diabetic with excruciating pain in ear, appearance of granulation in meatus, skull base infection with facial paralysis should be treated with?

In this case, all the clinical features are suggestive of malignant otitis externa, an inflammatory condition of the external ear. Malignant otitis externa (also k/a Necrotizing external otitis). Treatment of necrotizing otitis externa requires aggressive management with intravenously administered antipseudomonal antibiotics (antipseudomonal penicillin or cephalosporin (3rd generation-piperacillin or ceftazidime) with an aminoglycoside. A fluoroquinolone antibiotic can be used in place of the aminoglycoside), which should be maintained for 8-12 week to facilitate sequestration of the infection. Aggressive debridement of granulation tissue within the ear canal is key to promoting the replacement of necrotic bone with ble tissue. Because necrotizing otitis externa is associated with extensive ischemia of the skull base, the operative debridement of the tympanic bone, the mastoid, and the skull base is indicated only when medical treatment fails to improve.