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Give ears some respite from regular microsuctioning in bisphosphonate-induced osteonecrosis of the external ear canal

Published online by Cambridge University Press:  06 April 2022

E Abelardo*
Affiliation:
ENT – Head and Neck Surgery Department, Hywel Dda University Health Board, Carmarthen, Wales, UK
M Jaramillo
Affiliation:
ENT – Head and Neck Surgery Department, Hywel Dda University Health Board, Carmarthen, Wales, UK
*
Author for correspondence: Mr Edgardo Abelardo, ENT-HNS Department, Glangwili General Hospital, CarmarthenSA31 2AF, Wales, UK E-mail: e.abelardo@swansea.ac.uk

Abstract

Background

This paper reports a case series of three elderly patients who were regularly attending ENT clinic every four to six weeks for ear canal care to address chronic otitis externa. All three patients had been taking bisphosphonate alendronic acid for years, and it is suspected that this drug was partly to blame for the progression of their chronic ear conditions.

Results

Some improvements were noted when the bisphosphonate was discontinued. The regular microsuctioning, and application of topical antibiotics with steroids, provided temporary relief of symptoms. The present pandemic shut down the routine clinic and the patients were not seen for four to five months. On latest review, it was a surprise to see that their ears seemed to have significantly improved, with healthy re-epithelialisation.

Conclusion

It is thus believed that excessive and repeated microsuctioning in bisphosphonate-induced osteonecrosis of that external ear canal can delay re-epithelialisation, and gradually prolonging the intervals between microsuctioning could help in overall resolution of the disease.

Type
Clinical Records
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

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Footnotes

Mr E Abelardo takes responsibility for the integrity of the content of the paper

Presented as poster at the British Academic Conference of Otolaryngology 2018 International Conference, 4–6 July 2018, Manchester, UK.

References

Froelich, K, Radeloff, A, Kohler, C, Mlynski, R, Muller, J, Hagen, R et al. Bisphosphonate-induced osteonecrosis of the external canal: a retrospective study. Eur Arch Otorhinolaryngol 2011;268:1219–2510.1007/s00405-011-1496-zCrossRefGoogle ScholarPubMed
Side effects for all bisphosphonates. In: https://bnf.nice.org.uk/drug/alendronic-acid.html#sideEffects [27 September 2020]Google Scholar
Thorsteinsson, A-L, Vestergaard, P, Eiken, P. External auditory canal and middle ear cholesteatoma and osteonecrosis in bisphosphonate-treated osteoporosis patients: a Danish national register-based cohort study and literature review. Osteoporos Int 2014;25:1937–4410.1007/s00198-014-2684-7CrossRefGoogle ScholarPubMed
Marx, RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115–1710.1016/S0278-2391(03)00720-1CrossRefGoogle ScholarPubMed
Khosla, S, Bilezikian, JP, Dempster, DW, Lewiecki, EM, Miller, PD, Neer, RM et al. Benefits and risks of bisphosphonate therapy for osteoporosis. J Clin Endocrinol Metab 2012;97:2272–82Google ScholarPubMed
International Classification of Diseases 11th Revision. In: https://www.who.int/classifications/icd/en/ [17 October 2020]Google Scholar
McCadden, L, Leonard, CG, Primrose, W. Bisphosphonate-induced osteonecrosis of the ear canal: our experience and a review of the literature. J Laryngol Otol 2018;132:372–410.1017/S0022215118000324CrossRefGoogle Scholar
Salzman, R, Hoza, J, Perina, V, Starek, I. Osteonecrosis of the external auditory canal associated with oral bisphosphonate therapy: case report and literature review. Otol Neurotol 2013;34:209–1310.1097/MAO.0b013e31827ca34dCrossRefGoogle ScholarPubMed
Thorasteinsson, AL, Lomholt, AF, Eiken, P. Bisphosphonate-induced osteonecrosis of the external auditory canal: a case report. J Clin Med Case Reports 2015;2:3Google Scholar
Whitaker, M, Guo, J, Kehoe, T, Benson, G. Bisphosphonates for osteoporosis – where do we go from here? N Engl J Med 2012;366:2048–51Google Scholar