Bisphosphonate-Induced Osteonecrosis of the External Auditory Canal: A Case Report

Objective: Worldwide millions of patients are treated with bisphosphonates (BPs) for osteoporosis and cancer-associated bone diseases. In recent years rare side effects as osteonecrosis of the jaw and atypical femur fracture have been reported to be associated with long-term treatment with BP. A national register-based cohort study and eight cases of BP-associated osteonecrosis/cholesteatoma of the external auditory canalhave been reported in the world literature. Methods: In this study we present a case with a 76-year old female diagnosed with bilateral osteonecrosis of the external auditory canal possibly due to long-term oral and intravenous BP treatment of osteoporosis. Conclusion: BP-associated osteonecrosis of the external auditory canal is a rare and still relatively unknown condition. The case underlines the significant impact of the diagnosis and its complications on quality of life. Although BP induced osteonecrosis is rare, the large volume of BP prescriptions makes the number of patients at risk significant. However we still think that the benefits of therapy with BPs in osteoporosis patients with high risk of fractures outweigh the risk of osteonecrosis of the external auditory canal.