Otitis media refractory to therapy as a symptom of malignant disease

Recurrent otitis media (OM) is common in childhood and is usually caused by adenoid hyperplasia. However, there are also rare other causes of therapy-resistant OM. In case of inconsistencies in the history or unclear constellation of findings, one should therefore vigilantly search for rare differential diagnoses. The following presentation of findings describes such a case. A 12-year-old patient presented with a left OM that had been refractory to therapy for 3 months. As a child, there had been no OM, the current disease had occurred without a constellation of infections, and the nasopharynx was clear on admission. Despite i.v. antibiotic therapy and a paracentesis as well as the insertion of a ventilation tube, the findings did not improve, so after 2 weeks an MRI of the temporal bone was performed to exclude a mastoid pathology. Reevaluation revealed a now large tumor in the epipharynx with auditory canal infiltration and incipient facial paresis. Transnasal histologic confirmation was performed. This revealed a G3 embryonal rhabdomyosarcoma of the nasopharynx, and PET-CT showed no distant. The patient was assigned to the high-risk group E. Therapy was initiated according to the CWS guidance of the GPOH. Restaging by MRI showed a clear response to therapy and the paresis was regressive. Already the initial combination of findings showed peculiarities, several factors indicated an unusual constellation. In such situations, one must also consider rare differential diagnoses of a common clinical picture and, in case of doubt, initiate extended diagnostics.

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Publication History

Article published online:
27 June 2023