Fungal malignant otitis externa: pitfalls, diagnosis, and treatment.

Hypothesis: Oral voriconazole is a viable alternative modality treatment to traditionally used intravenous vancomycin in the treatment of malignant otitis externa (MOE).

Background: The incidence of MOE is on the rise, more so in Saudi Arabia where diabetes mellitus is endemic. Although Pseudomonas aeruginosa is the most common offending organism, we are observing an increasing number of fungal MOE, in particular, Aspergillus species.