Resistant otorrhea in a diabetic; revealing form of an exceptional carcinoma of the external ear canal

Malika El Omri; Jemli S; Bellakhdher Mouna; Meherzi Abir; Houas Jihene; Ghammem Monia; Ach Taieb; Kermani Wassim; Abdelkefi Mohamed

doi:10.1530/endoabs.99.EP1122

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Endocrine Abstracts (2024) 99 EP1122 | DOI: 10.1530/endoabs.99.EP1122

ECE2024 Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (383 abstracts)

Resistant otorrhea in a diabetic; revealing form of an exceptional carcinoma of the external ear canal

El Omri Malika , Jemli S , Bellakhdher Mouna , Meherzi Abir , Houas Jihene , Ghammem Monia , Ach Taieb ² , Kermani Wassim & Abdelkefi Mohamed

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ENT Department Farhat Hached hospital, Sousse, Tunisia; ²Endocrinology Department Farhat Hached Hospital, Sousse, Tunisia

Introduction: Necrotizing otitis externa (NOE) is a serious pathology frequently observed in diabetics. Its differential diagnosis of carcinoma of the external auditory canal (EAC) is, however, a rare pathology observed only in 0.2% of cases, the most frequent histological type is epidermal carcinoma, adenoid cystic carcinoma (ACK) is exceptionally observed. We report the case of ACK treated in our department initially considered as an NOE and whose diagnosis was made on deep biopsies. The aim of our work is to draw attention of clinicians to a differential diagnosis of necrotizing otitis externa and to describe its therapeutic modalities.

Observation: A 70-year-old patient, type 2 diabetic evolving for 6 years, admitted for left ear pain associated with chronic otorrhea resistant to outpatient treatment. Physical examination revealed an inflammatory EAC. No granulation tissue or protruding polyp was found. Temporal Computed tomography showed the appearance of a left NOE without endocranial extension. Bacteriological and mycological samples were negative initially then positive for corynebaceruim. The patient was then put on antibiotics for 21 days with good control of her diabetes and regular local care, without any improvement. Given the slow progress, it was decided to perform deep bone biopsies which were in favor of a ACK of the CAE. The patient underwent a lateral petrectomy followed by adjuvant radiation. The evolution was favorable.

Conclusion: The place of deep biopsy in NOE is controversial, but it can sometimes support a differential diagnosis in the face of the dragging evolution of a well-monitored NOE.