We report two cases of malignant external otitis (MEO) evaluated with Technetium-99m((99m)Tc)-labelled sulesomab. Two patients affected by MEO are presented, together with a literature review. Both patients were studied with clinical examination, ear discharge culture, radiological imaging, blood exams, (99m)Tc Sulesomab, and treated with antibiotic therapy. (99m)Tc-Sulesomab would appear to be an useful tool for diagnosis and follow-up of MEO, highlighting the site and extension of the inflammatory process, and evaluating course and treatment efficacy. (99m)Tc-Sulesomab shows promise as a rapid, effective and safe imaging agent for treatment response evaluation and follow-up of patients with MEO. Further studies are warranted to validate the inclusion of (99m)Tc-Sulesomab scan in the imaging follow-up of patients with MEO.