We performed a 15-year retrospective audit of all cases of malignant otitis externa (MOE) referred to Alice Springs Hospital in Central Australia from 2009 to 2024, the largest Australian series of MOE. Data on demographics, risk factors, microbiological culture results, management and outcomes were collected, identifying 64 cases of MOE, with the incidence increasing over time. The incidence of MOE was associated with Indigenous status and the presence of diabetes mellitus and chronic kidney disease. Pseudomonas, Staphylococcus aureus and fungal pathogens predominate as causal agents. Complications and mortality were common.