الفهرس 
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Abstract
Out of 1002 patients in our study there is 424 were males and 578 were females. The age of studied patient ranged from 14 to 91 years. Eight hundred and four patients were not complained of any ear problems and their ear examination was found free clinically. One hundred and ninety-eight patients had ear problems as follow: - Sixty patients complained of diminution of hearing with normal ear examination. - Fifty-one patients complained of diminution of hearing with ear wax that was found on examination that was managed as outpatients. - Forty-nine patients complained of otalgia of duration less than 15 days and examination revealed acute diffuse otitis externa (32 patients), AOM (9 patients). And ear furuncle (10 patients, 2 of them were admitted after failure of treatment as outpatients). -nineteen patients complained of otalgia of duration more than 15 days and examination of those cases reveal: - MOE in 12 patients. - Unresolved AOM in 4 patients. - Ear furuncle resistant to treatment (2 patients). - One patient with resistant otitis externa due to foreign body. - Nineteen patients were complained of ear itching and their examination reveal otomycosis (12 patients) and was found free except for scratching marks (7 patients) and managed as outpatients. Out of the 198 patients complained of ear problems, 19 of them were admitted to hospital, complained of otalgia of duration more than 15 days received the regimen of treatment including systemic corticosteroids. The response to the treatment was 100% for otalgia, edema of the external canal, granulation tissue, preauricular edema and tenderness, temporomandibular joint affection and polyp at the EAC, 93% for ear discharge and 0% for diminution of hearing, tinnitus and facial nerve palsy. Recurrence after resolution was 16% and re-admission was done. The complications detected after systemic dexamethasone was hyperglycemia in 100% of patients -controlled by increasing the dose of insulin-, gastric upset and gastroesophageal reflux in 52% so addition of proton pump inhibitor was done. Infections in diabetic patients should be handled aggressively and seriously. Resistance of infection in those patients is due to poor control of blood glucose, poor compliance of patient mainly because of poverty and illiteracy and under treatment prescribed by doctors. Otalgia is the main complaint of diabetic patients with resistant external and/or middle ear infection that is a nightmare for both patients and otolaryngologists. Not all cases complaining of otalgia with granulation tissue in the EAC that resist medical treatment are MOE. Admission to the hospital is a rule in diabetic patients with resistant ear infection and strict control of blood glucose level must be done, otherwise no use of prescription of antibiotics with local ear drops. In infection of EAC (MOE or resistant otitis externa) frequent cleaning and removal of any discharge or debris should be done to ensure efficacy of the local treatment. Dexamethasone is a cheap, effective and available medication that has a magic effect in controlling of inflammation which helps complete and rapid resolution of resistant ear infection with antibiotics and also a potent analgesic that relieve otalgia and improve the quality of life.