Objective The prognosis of patients with malignant external otitis (MEO) depends on the extent of the inflammatory changes in the temporal bone and skull base. The efficacy of high-resolution computed tomography (HRCT) imaging in accurately assessing the extent of disease is compared with that of single-photon emission computed tomography/computed tomography (SPECT/CT) scan. Study Design A clinical chart review was conducted with medical records and radiologic images. Setting Tertiary care medical college hospital. Subjects and Methods This study involved patients with clinically diagnosed MEO who underwent both modalities of imaging of the skull base. Staging of the disease extent was compared between the imaging systems among patients. Symptom control and survival rates were analyzed with respect to the SPECT/CT staging of MEO. Results Out of 28 patients included in this study, 72% had SPECT/CT scans showing higher staging than the HRCT imaging. Four patients had mild uptake (stage 1), and 15 had disease confined to the mastoid/temporal bone, not reaching midline (stage 2). All patients in stages 1 and 2 were surviving with good symptom control. Five patients with petrous involvement reaching midline (stage 3) had persistent symptoms, and all 4 cases with SPECT/CT showing sphenoid involvement and crossing midline (stage 4) died within a year of diagnosis. Conclusions SPECT/CT scan is more sensitive than HRCT imaging in detecting the extent of disease and is a better prognosticator for patients with MEO.

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