This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: ENT
A 75-year old diabetic patient presents wain severe ear pain and granulation tissue at external auditory canal with facial nerve involvement. -The most likely diagnosis is: 
Select and explain. 
A. Malignant otitis externa, B. Nasopharyngeal carcinoma, C. Acute suppurative otitis media, D. Chronic suppurative otitis media
A: Malignant otitis externa
Answer: A: Malignant otitis externa 
Explanation: Ans. a. Malignant otitis externa Presence of a painful lesion in the external ear with the evidence of granulation tissue and associated cranial nerve palsies (VII nerve) in a diabetic (or immunocompromised) patient suggest a diagnosis of malignant otitis externa