Malignant otitis externa, although it is not a malignancy, it behaves and spreads like one, hence the name.  The first case of MOE was reported in 1938, and the term ‘malignant otitis externa’ was described later by Chandler in 1968, due to its high fatality rate in that time. Malignant otitis externa is a life-threatening infection that mainly affects the external auditory canal and skull base, and the infection can also invade the stylomastoid and jugular foramina. Infection and inflammation can take different anatomical routes through the osteocartilaginous junction or osseous canal toward the mastoid process posteriorly, or toward the temporomandibular joint, parotid gland and cervicofacial spaces anteriorly, or medially into skull base. The disease ends up with osteomyelitis of the temporal bone after starting as simple otitis externa. Malignant otitis externa has an association with many serious complications, including cranial nerve involvement and increased rates of morbidity and mortality. Therefore, malignant otitis externa should be identified and treated urgently.