Background: Otomycosis is a fungal infection of the external auditory canal (EAC), mostly caused by Aspergillus and Candida species and very rarely by Scedosporium apiospermum. We present a healthy 73-year-old beekeeper with chronic bilateral otorrhea secondary to S. apiospermum complicated by benign osteonecrosis of the EAC. Benign osteonecrosis of the EAC is an exceedingly rare condition, and S. apiospermum has not previously been reported as its causative agent in the medical literature. Case presentation: The patient had a one-year history of chronic otorrhea treated with regular microdebridement and Kenacomb. Mucosal defects of both external auditory canals were present with a thin layer of mucosa covering the defect on the left. S. apiospermum was detected on targeted swabs with CT confirming bilateral osseous erosion. High-dose topical Clotrimazole was started for 6 weeks, as per culture and sensitivity results. Discussion: S. apiospermum is a soil-based saprophytic hyalohyphomycete with non-pigmented branching septate hyphae. It most commonly causes multi-system infections in patients who suffered near-drownings, in the immunocompromised, and rarely causes isolated infections. Systemic Voriconazole or Posaconazole is effective in treating S. apiospermum fungaemia. Kenacomb contains Triamcinolone acetonide, Neomycin, Gramicidin and Nystatin, which is the only antifungal agent. Sensitivities revealed resistance to Nystatin, with a minimum inhibitory concentration of 8mg/ml, and susceptibility to Posaconazole with increased exposure and sensitivity to Clotrimazole and Voriconazole. Conclusion: This case highlights the importance of early detection by means of targeted swab cultures that allows accurate identification of the pathogen and facilitates prompt initiation of treatment to prevent complications.