ABSTRACT
We present a case of non-surgically managed bilateral osteonecrosis of the external auditory canal with a history of long-term medical therapy for osteoporosis. A 79-year-old woman with severe osteoporosis and destructive osteoarthritis received >10 years of once weekly bisphosphonate therapy before switching to denosumab. Four months later, the patient presented with bilateral loss of hearing and right-sided otalgia. Necrotising otitis externa, cholesteatoma and malignancy were considered but with histology, microbiological and CT assessment, bilateral osteonecrosis of the external auditory canal was diagnosed. Surgical debridement with canalplasty was avoided due to our patient's comorbidities. Treatment continued for 5 months with regular aural toilet, Terra-Cortril ointment and bismuth-iodine-paraffin paste packing. At 1-year follow-up, bilateral external auditory canals were completely re-epithelialised with no pain or affected hearing. We report the first case of bilateral osteonecrosis of the external auditory canal associated with denosumab and bisphosphonates with successful conservative management.
Subject(s)
Bisphosphonate-Associated Osteonecrosis of the Jaw , Cholesteatoma , Aged , Bisphosphonate-Associated Osteonecrosis of the Jaw/diagnostic imaging , Bisphosphonate-Associated Osteonecrosis of the Jaw/surgery , Denosumab/adverse effects , Diphosphonates , Ear Canal/diagnostic imaging , Female , HumansABSTRACT
The authors report a previously undocumented case of parapharyngeal rhabdomyosarcoma presenting as Gradenigo's syndrome and review the history and aetiology of Gradenigo's syndrome. With sensitive diagnostic acumen this rare cause of Gradenigo's like syndrome was identified and correct treatment initiated.
