Rare differential diagnosis of therapy-resistant external otitis: the auditory canal carcinoma

Introduction Auditory canal cancers are among the rare tumor entities with an incidence of 1.4 to 1 million inhabitants. In most cases (about 90 %) they are squamous cell carcinomas. The tumor stage is a crucial factor for survival.

The symptoms such as unilateral otalgia, otorrhoea and swelling of the ear canal often lead to the misdiagnosis of acute or chronic otitis externa.

Methods A 54-year-old patient was assigned to us with the diagnosis of a therapy-resistant left-sided otitis externa. Initially, a therapy with ointment stripe insert and ear care was done. After the first 2 weeks, an improvement had occurred, but a short time later, the patient had again the same symptoms. Thereafter, the patient was for another six weeks with an antibiotic p.o. and local therapy have been treated without success.

Results In a CT of the petrous bone, a bone erosion of the ear canal was found ventrally in the direction of the temporomandibular joint. The ensuing sampling revealed a squamous cell carcinoma G2. After the staging examinations, a cT3 cN0 M0 left auditory meatocarcinoma was found. Following the recommendation of the interdisciplinary tumor board, the tumor resection of the ear canal was performed with mastoidectomy, lateral parotidectomy and selective left neck dissection Regio II-III. Postoperatively, the patient received adjuvant chemoradiotherapy.

Discussion Even if the ear cancers are a rare disease, it should always be considered as a differential diagnosis in therapy-resistant otitis externa, since the symptoms are very similar and an early diagnosis may be crucial for the prognosis.

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Artikel online veröffentlicht:
10. Juni 2020