Malignant otitis externa (MOE) is a potentially fatal infection of the external auditory canal caused by Pseudomonas aeruginosa in a majority of cases. Treatment of MOE has changed over the years. Surgical debridement of all infected tissue is no longer considered the treatment of choice and has been replaced by localized surgical debridement supplemented with long-term antimicrobial chemotherapy. The recent availability of the fluoroquinolones and in particular ciprofloxacin has opened up new therapeutic opportunities.