Patient had also complained of persistent dull temporal headache

A 62 ear old diabetic male came to the ENT OPD with complaints of severe deep seated pain in his left ear since 3 days which exacerbates on chewing and is accompanied by persistent purulent foul smelling discharge. Patient had also complained of persistent dull temporal headache. There was no complaint/history of fever.
On General Examination:
Temperature was 97°F, Pulse 72/mint, BP 140/80 mg.
Ear Inspection:
Grossly: tenderness and swelling around the external left ear orifice upto the mastoid tip with swollen and engorged pinna leaking purulent discharge with fruity odor.
Otoscopy: TM intact.

Granulation tissue was observed at the floor of the osseo-cartilaginous junction.
WorkUp
CBP: leukocytosis
GRBS: 280 mg/do
ESR: 87 mm/he (raised)
Swab with the purulent collection was sent for culture and sensitivity and smear examination revealed slender gram negative bacelli among plenty of pus cells.
Patient was then started on Ciprofloxacin oral therapy and had been posted for aural toileting and CT & MRI examination to determine the anatomical extent of the disease.
Blood sugar levels were monitored and controlled by strict adherence to prescribed anti-diabetic medication.