Osteonecrosis of the external auditory canal associated with oral bisphosphonate therapy: case report and literature review.
Otol Neurotol
; 34(2): 209-13, 2013 Feb.
Article
em En
| MEDLINE
| ID: mdl-23444468
ABSTRACT
OBJECTIVE:
To present the first case of a patient with oral bisphosphonates-associated ear canal osteonecrosis (BPECO), review previously published cases, and suggest a definition of BPECO. PATIENT A 79-year-old woman with left otorrhea and earache was treated for otitis externa for 2 months. The examination revealed a deep floor of the left ear canal defect. The bisphosphonates were discontinued. By the end of the 6-week-course of intravenous antibiotics, the bone defect progression ceased. Already a month later, the defect was lined from approximately 50%. Unfortunately, the patient was lost to follow-up at this stage. She was on oral bisphosphonates for 10 years for severe osteoporosis. She had never been exposed to radiotherapy or had any surgery in the left ear. She admitted to be a habitual cotton bud user for aural toilet.RESULTS:
A CT scan showed an aggressive lobulated mass consistent with carcinoma. A biopsy suggested osteomyelitis with no evidence of malignancy. The final diagnosis was agreed to be the first case of oral BPECO. INTERVENTION Debridement, intravenous antibiotics, and cessation of bisphosphonatesCONCLUSION:
The BPECO is not very well-known clinical diagnosis among ENT surgeons and, therefore, often misdiagnosed for ear canal cholesteatoma, malignant otitis externa, or temporal bone malignancies. It seems reasonable to re-review patient's medical history with focus on BP medication in cases with negative biopsy. Although the BP osteonecrosis is a rare phenomenon, the large volume of BP prescription makes the number of patients at risk significant.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Meato Acústico Externo
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Otopatias
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Conservadores da Densidade Óssea
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Osteonecrose da Arcada Osseodentária Associada a Difosfonatos
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article