A 60-year-old diabetic patient presents with extremely painful lesion in the external ear and otorrhea not responding to antibiotics. There is evidence of granulation type tissue in the external ear and bony erosion with facial nerve palsy is noted. The most likely diagnosis is

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 external but there is excruciating pain and appearance of granulations in the ear canal. Facial palsy is common. Infection may spread to the skull base and jugular foramen causing multiple cranial nerve palsies. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 55)