Malignant otitis externa (MOE) is an invasive external ear infection that spreads to adjacent soft tissues and osseous structures. MOE may progress to skull base osteomyelitis, causing life-threatening extra- or intracranial complications. Pseudomonas aeruginosa is the most common pathogen associated with MOE. Immunocompromised individuals and elderly diabetic patients are particularly susceptible to MOE, which is typically associated with severe otalgia and otorrhea. Imaging is crucial for early diagnosis and recognizing complications. Radiologists should consider the diagnosis of MOE while reporting CT scans and temporal MRIs and pay attention to key diagnostic findings; otherwise, it may be easily overlooked.