One case of malignant external otitis in a non-diabetic patient is presented. Malignant external otitis is a rare but severe bacterial infection, caused by Pseudomonas aeruginosa, predominantly in elderly diabetic patients. The process starts in the external auditory canal and after crossing the cartilaginous-osseus junction invades the connective tissue, cartilage, bone, and nerves of the temporal bone and the surrounding parts of the base of the skull. The clinical syndrome is a severe, painful inflammation of the external auditory canal with edematous obstruction of the external canal and typical granulation tissue in the canal wall. Diagnostic criteria are pain, edema, exudate, granulations, microabscess, diabetes, old age, identification of Pseudomonas aeruginosa, and even cranial nerve involvement. Further important criteria are failure of local treatment and a positive Tc-99 scan demonstrating osteomyelitis of the temporal bone as a sign of connective tissue, cartilage, and bone invasion. In most cases there is also a positive radiograph or HR-CT of the base of the skull. Except for sequestrations, surgical treatment in malignant external otitis is impractical because of the deep penetration into the base of the skull and the lack of demarcation lines in this diffuse pathological process. Nowadays long term i.v. antibiotic therapy is preferred. In our case we applied Ceftazidim (Fortum) 2 g for 12 weeks twice a day. After this period the patient was completely cured. Our case demonstrates that malignant external otitis should be considered even in non-diabetic patients.

Fine needle capillary technique offers several advantages. Without aspiration trauma to cells and tissues is reduced. Less blood in the samples results in higher quality of the cytological smear. These circumstances make it easier for the pathologist to comment the cytological findings. The handling of the needle is practiced with a wrist movement and not from the shoulder joint as in aspiration method using the Cameco syringe holder. This allows for a more sensitive puncture technique touching the lesion during sampling with the finger tips. The puncture causes less pain than the aspiration technique. Our results demonstrate that fine needle capillary technique is the better method of fine needle biopsy in the head and neck region.

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Our case demonstrates that the first manifestation of sarcoidosis can be in the paranasal sinuses.

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