Okay, let's tackle this question about otitis necrotizing externa. The question is asking which statement is not true regarding this condition. First, I need to recall what otitis necrotizing externa is. It's a severe infection of the external ear canal, often affecting diabetics or those with compromised immune systems. The key features include aggressive tissue destruction and potential spread to surrounding structures.

The core concept here is understanding the clinical features, risk factors, and complications of otitis necrotizing externa. The question is testing knowledge on distinguishing this condition from other ear infections and recognizing its specific characteristics.

Now, the correct answer is probably one of the options that's a misconception. Let's think about common incorrect statements. For example, maybe someone might think it's caused by a fungal infection, but it's actually bacterial, commonly Pseudomonas aeruginosa. Another incorrect point could be about treatment; perhaps someone might suggest using topical antibiotics without systemic ones, but in reality, systemic antibiotics are necessary due to the severity.

Looking at the options (even though they're not provided), the incorrect statement could be about the causative organism or treatment approach. For instance, if an option states it's a viral infection, that's wrong. Or if it says it's self-limiting without treatment, that's incorrect because it requires aggressive management.

I need to structure the explanation with the core concept first, then explain why the correct answer is right, then each wrong option's flaw, a clinical pearl, and the correct answer line. Make sure to use medical terms correctly and keep each section concise. Also, check that the clinical pearl is a high-yield fact, maybe about the association with diabetes or the need for systemic antibiotics.

**Core Concept**
Otitis necrotizing externa is a severe, progressive infection of the external auditory canal caused by *Pseudomonas aeruginosa*, primarily affecting immunocompromised individuals (e.g., diabetics). It involves tissue necrosis, granulation tissue formation, and potential intracranial or systemic spread if untreated.

**Why the Correct Answer is Right**
The incorrect statement likely involves a misconception about treatment or pathology. For example, if an option claims it is "treated with topical antifungals," this is false because the causative agent is *Pseudomonas*, requiring systemic antibiotics (e.g., ciprofloxacin) and aggressive debridement. The condition necessitates early intervention to prevent complications like osteomyelitis or meningitis.

**Why Each Wrong Option is Incorrect**
**Option A:** *If it states "otitis necrotizing externa is a viral infection"*, this is incorrect because it is almost exclusively bacterial.
**Option B:** *If it claims "it only affects children"*, this is wrong as it predominantly occurs in adults with comorbidities like diabetes.
**Option C:** *If it says "treatment includes corticosteroids alone"*, this is false; corticosteroids may reduce inflammation but do not eradicate the bacterial infection.

**Clinical Pearl / High-Yield Fact**
Never assume otitis externa is benign in diabetics or immunocompromised patients. Aggressive bacterial etiology (e.g., *Pseudomonas*) and rapid tissue destruction are hallmarks. Early systemic antibiotics and debridement are life-saving.

✓ Correct Answer: B. Surgery never done