The patient gives history of trivial trauma to the ear often by ear buds, followed by pain and swelling involving the external auditory canal. pain is often the common initial presentation. it is often severe, throbbing and worse during nights. it needs increasing doses of analgesics. on examination granulation tissue may be seen occupying the external canal. it often begins at the bony cartilagenous junction of the external canal. discharge eminating from the external canal is scanty and foul smelling in nature. when the discharge is foul smelling it indicates the onset of osteomyelitis. ironically the patient does not have fever or other constitutional symptoms.otoscopy: reveals granulation tissue at the bony cartilagenous junction. the ear drum is usually normal. the external auditory canal skin is soggy and edematous.cranial nerve palsies are common when the disease affects the skull base. the facial nerve is the most common nerve affected. as the disease progresses the lower three cranial nerves are affected close to the jugular foramen. intracranial complications like meningitis and brain abscess are also known to occur.
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