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A 60-year-old diabetic patient presented with excruciating pain in the left ear for two weeks and facial palsy. Examination showed granulations in the external auditory canal. ESR was elevated at 60 mm/hr. The most likely diagnosis is malignant otitis externa. Investigations that should be ordered include biopsy and MRI temporal bone. Treatment involves long-term antifungal and antibiotic therapy.

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medical notes

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EN