Otitis externa has varying degrees of chronicity and severity. Acute otitis externa refers to a process of less than 6 weeks’ duration, while chronic otitis externa lasts more than 3 months. Treatment of both includes ototopical agents and appropriate aural hygiene. Chronic otitis externa often requires routine debridement by an otolaryngologist. Malignant otitis externa is now referred to as osteomyelitis of the temporal bone. Patients will often have excruciating pain on examination. Granulation tissue at the cartilaginous–bony junction is a hallmark of the disease, but not always encountered. Cranial neuropathies such as facial nerve paralysis can occur.