Synchronous Malignant Otitis Externa and Squamous Cell Carcinoma of the External Auditory Canal

Objectives. To discuss the management of a squamous cell carcinoma in the presence of malignant otitis externa. Study Design. We present only the third reported case in the literature of a synchronous tumour with malignant otitis externa in the literature. Methods. A case report and review of malignant otitis externa and squamous cell carcinomas of the external auditory canal are discussed. Results. A 66-year-old female is presented here with a 2-month history of a painful, discharging left ear refractory to standard antibiotic therapy. Computerised tomography, magnetic resonance imaging, technetium 99？m, and gallium citrate Ga67 scans were consistent with malignant otitis externa. Biopsy in the operating theatre revealed a synchronous squamous cell carcinoma of the external auditory canal. Primary resection of the tumour and surrounding tissues was performed with concomitant treatment with intravenous antibiotics. Conclusions. This is only the third case to be reported in the literature and highlights several important diagnostic and management issues of these two rare conditions. Both conditions may present in a similar manner on clinical assessment and radiological investigations. Aggressive management with surgical resection and treatment with appropriate intravenous antibiotics is necessary to give the best chance for cure. 1. Introduction Malignant otitis externa (MOE) is a rare and potentially fatal invasive infection of the skull base. It can arise as a result of an infection of the external auditory canal “malignant otitis externa,” the middle ear, and sinusitis and as a complication of surgery of the skull base [1–3]. Although a variety of organisms can cause MOE, the predominant organism responsible for the infection is Pseudomonas aeruginosa, although fungal species such as Aspergillus may also be involved [3]. Squamous cell carcinomas (SCC) arise from the skin of the external auditory canal and are relatively rare entities. They are most common in individuals in their 6th decade of life and may be related to chronic infection, radiation exposure, and sun or cold exposure. Both squamous cell carcinomas of the external auditory canal and malignant otitis externa can present with a painful, discharging ear with granulation tissue involving the external canal refractory to initial antimicrobial therapy [4]. This case highlights the importance of a multidisciplinary team approach to both the diagnosis and treatment of these rare pathologies and reinforces the importance of biopsy in the diagnosis of two diseases, which are virtually