ENT Department, Olomouc University Hospital and Medical School, Palack] University, Olomouc, Czech Republic.
Otol Neurotol. 2013 Feb;34(2):209-13. doi: 10.1097/mao.0b013e31827ca34d.
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.
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.
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.
Debridement, intravenous antibiotics, and cessation of bisphosphonates
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.
报告首例口腔双膦酸盐相关性耳道骨坏死（BPECO）患者，回顾既往文献报道，并提出 BPECO 的定义。
一位 79 岁女性，因左耳流脓伴耳痛就诊，曾在外耳道炎治疗 2 个月。检查发现左耳道深部地板缺陷。停用双膦酸盐。静脉抗生素 6 周疗程结束时，骨缺损进展停止。但在抗生素治疗结束后 1 个月，骨缺损已修复约 50%。不幸的是，此时患者失访。她因严重骨质疏松症口服双膦酸盐 10 年，从未接受过放疗或左耳部手术。她承认经常使用棉签进行耳内清洁。
CT 扫描显示侵袭性分叶状肿块，符合癌的表现。活检提示骨髓炎，无恶性证据。最终诊断为首例口腔 BPECO。
清创、静脉用抗生素、停用双膦酸盐。
BPECO 在耳鼻喉科医生中并不是一个广为人知的临床诊断，因此常被误诊为耳道胆脂瘤、恶性外耳道炎或颞骨恶性肿瘤。对于活检阴性的病例，有理由重新审查患者的病史，重点关注双膦酸盐药物。尽管双膦酸盐相关的骨坏死是一种罕见现象，但大量的双膦酸盐处方使风险患者数量显著增加。
