Physical examination of the ear canal will reveal findings indicative of acute, chronic, and malignant necrotizing otitis externa. In acute otitis externa, the patient can appear ill if the cause is infectious and is accompanied by fever. Patients with chronic otitis externa are usually well-appearing. Malignant necrotizing otitis externa patients are usually ill-appearing due to the accompanying fever and facial palsies.

• The following physical exam findings in the ear canal are indicative of otitis externa:^[1]
  • Erythema and edema.
  • Tenderness of the tragus and auricle.
  • Cellulitis of the auricle and ear canal.
  • Otorrhea
  • Granulation tissue
  • Stenosis of the ear canal.
  • Buildup of mycotic debris.^[2]
  • Lack of cerumen.
• In the neck, lymphadenitis may be present in acute otitis externa.^[3]
• In malignant necrotizing otitis externa, the patient may present signs of trismus and partial facial palsy.^[4]

• For acute otitis externa, the patient can appear ill if the cause is infectious and is accompanied by fever.^[5]
• Patients with chronic otitis externa are usually well-appearing.
• Malignant necrotizing otitis externa patients are usually ill-appearing due to the accompanying fever and facial palsies.^[4]

• 
  A severe case of acute otitis externa. Note the narrowing of the external auditory channel, the prominent amounts of exudate and swelling of the auricle. Case presented by James Heilman, MD.
• 
  A mild case of otitis externa. Case presented by Klaus D. Peter.