We present a 50-year-old male with Pneumocystis carinii infection involving the middle ear and the external auditory canal as the first manifestation of a previously unknown HIV infection. In case of therapy-resistant otitis with a polypoid mass in the external auditory canal histological evaluation should be considered to rule out malignancy or pathogens, like Pneumocystis carinii, that cannot be cultured. Oral or intravenous antiprotozoal agents are the treatment in line with current practice. Exploration of the os petrosum is never required.
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