Recognizing bisphosphonate-induced ear osteonecrosis in primary care: a case report

Area of Science:

• Otolaryngology
• Primary Care Medicine
• Pharmacology

Background:

• Medication-related ear canal osteonecrosis (MRECO) is an emerging concern associated with prolonged anti-resorptive medication use.
• Primary care providers are key prescribers of these medications, yet MRECO awareness in primary care literature is limited.
• This case highlights bisphosphonate-induced osteonecrosis of the external auditory canal (EAC).

Observation:

• A 65-year-old female on long-term alendronic acid for osteoporosis presented with a two-year history of left-sided ear blockage and itchiness.
• Persistent symptoms despite topical treatment led to an Otolaryngology referral, where exposed bone in the left EAC was discovered.
• Computed tomography confirmed bony erosion of the left EAC.

Findings:

• Bisphosphonate-induced osteonecrosis of the external auditory canal (MRECO) was diagnosed in the absence of other risk factors.
• Management included bisphosphonate discontinuation, regular aural toilet, and topical treatment.
• Complete ear canal epithelialisation was achieved within six months.

Implications:

• MRECO is expected to increase with the aging population and wider use of anti-resorptive medications.
• Unexplained ear symptoms in patients with a history of anti-resorptive therapy warrant evaluation for EAC exposed bone.
• Increased awareness of MRECO among primary care providers is essential for early detection and prompt management.