Malignant otitis externa is characterized by all except

Malignant (necrotizing) otitis externa It is an inflammatory condition caused by pseudomonas infection usually in the elderly diabetics, or in those on immunosuppressive drugs. Its early manifestations resemble diffuse otitis externa but there is excruciating pain and appearance of granulations in the ear canal. Facial paralysis is common. Infection may spread to the skull base and jugular foramen causing multiple cranial nerve palsies. Anteriorly, infection spreads to temporomandibular fossa, posteriorly to the mastoid and medially into the middle ear and petrous bone. Diagnosis: Severe otalgia in an elderly diabetic patient with granulation tissue in the external ear canal at its cailaginous-bony junction should ale the physician of necrotizing otitis externa. CT scan may show bony destruction but is often not helpful. Gallium-67 is more useful in diagnosis and follow-up of the patient. It is taken up by monocytes and reticuloendothelial cells, and is indicative of soft tissue infection. It can be repeated every 3 weeks to monitor the disease and response to treatment. Technetium 99 bone scan reveals bone infection but test remains positive for a year or so and cannot be used to monitor the disease. Ref:- Dhingra; pg num:-52