Necrotizing otitis externa is a necrotizing osteomyelitis of the skull base that predominantly affects diabetic and immunocompromised patients. Pseudomonas aeruginosa is the most frequently implicated organism. Patients present with severe otalgia, otorrhoea with or without facial palsy, or rarely, facial pain as a symptomatic feature. We report a case of necrotizing otitis externa presenting with totally painless otorrhoea and highlight the need for a high index of suspicion when treating patients with otitis externa.
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