• Takanori Eguchi, Akihiko Basugi, Ikuyo Kanai, Yukinaga Miyata, Tomomitsu Nasuno, and Yoshiki Hamada.
• Department of Oral and Maxillofacial Surgery Department of Otorhinolaryngology, Toshiba Rinkan Hospital, Sagamihara Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, Yokohama, Japan.
• Medicine (Baltimore). 2018 May 1; 97 (21): e10898e10898.

RationaleAlthough an ototoxicity is well-known as adverse event of the radiotherapy, it is not widely known that immunosuppressed patients who underwent radiotherapy in head and neck region have risk of malignant external otitis.Patient ConcernsA 68-year-old man with diabetes, who had been diagnosed as intraosseous squamous cell carcinoma of the right mandible, underwent surgical resection. He received a total of 60 Gy/30Fr postoperative radiation. Four months after the course of radiation, he suffered from right aural fullness, otalgia and otorrhea.DiagnosesClinical examination revealed granulation and existence of Pseudomonas aeruginosa in the external auditory canal. Computed tomography showed expansive inflammation and erosion in the temporal bone. The patient is elderly and diabetes. These findings led to the diagnosis of malignant external otitis.InterventionsThe ear irrigation and administration of quinolones were started. Afterwards, fistula was formed in the oral cavity, and connected to the right external auditory canal. Therefore, irrigations were performed not only from ear but also from the oral fistula.OutcomesEight weeks after starting treatment, the malignant external otitis was completely healed.LessonsPhysicians should raise awareness of malignant external otitis in immunosuppressed patients with oral cancer after radiotherapy.

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