A case of malignant otitis externa with multiple cranial nerve deficits is presented. A 84-year-old diabetic male patient presented with severe right otalgia and otorrhea for two weeks and did not respond to ordinary treatment. The patient also noticed a progressive facial weakness on the same side. Despite 14-week intravenous antibiotic therapy and hyperbaric oxygen therapy, cranial nerve IX and X deficits followed and the patient died. Malignant otitis externa should be suspected in diabetic patients presenting with aural discharge not respond to ordinary treatment. Successful treatment depends on early diagnosis and proper therapy.