A 52-year-old man presents with severe ear pain and purulent drainage from the left ear for 3 weeks. He is a diabetic with poor glycemic control (HbA1c 9.2%). On examination, the external auditory canal is edematous and granulation tissue is visible. There is tenderness over the mastoid process and tragus. Otoscopy reveals purulent discharge obscuring the tympanic membrane. A CT scan of the temporal bone shows erosion of the cortical bone of the mastoid. Blood culture grows Pseudomonas aeruginosa. What is the most likely diagnosis?
A 38-year-old woman presents with itching and mild pain in the right ear for 5 days. She recently returned from a swimming holiday. On examination, the external auditory canal is erythematous and edematous, with scanty serous discharge. The tragus is tender to palpation. Otoscopy shows the tympanic membrane is intact and normal. She has no fever. Audiometry is normal. What is the most appropriate initial management?
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