Which of the following is a classic symptom of toxic-serious infections in patients with malignant otitis externa?

Malignant otitis externa, primarily caused by Pseudomonas aeruginosa, is a serious infection often seen in immunocompromised patients, particularly those with diabetes. A classic symptom associated with this condition is osteomyelitis, which occurs as the infection extends into the temporal bone. This can lead to ear pain, drainage from the ear, and necrosis of the surrounding tissues.

The presence of osteomyelitis indicates a deeper tissue involvement and serious nature of the infection, distinguishing malignant otitis externa from more common forms of otitis externa, which may present with ear canal inflammation and pain but do not typically involve the bone. Identifying osteomyelitis is crucial in directing appropriate treatment measures, as this condition can be life-threatening if not managed promptly.

Other symptoms such as fever, hematuria, and nausea may develop due to many other infections or conditions, but osteomyelitis specifically correlates with the severity and potential complications of malignant otitis externa, making it a key indicator of serious infection in these patients.