背景:药物相关的耳道骨坏死(MRECO)是一个与长期使用抗吸收药物有关的日益增加的问题。尽管初级保健提供者是这些药物的主要处方者,初级保健文献中有关MRECO的信息有限。本文介绍了一例双膦酸盐引起的外耳道(EAC)骨坏死,强调初级保健提供者在识别抗吸收药物的这种罕见但显著的副作用方面的重要作用。
■一位65岁的女性,长期服用阿仑膦酸治疗骨质疏松症,有2年的左侧耳塞和瘙痒病史的初级保健。尽管长时间局部治疗耳垢,症状持续存在,导致耳鼻喉科转诊。微抽吸显示左侧EAC中的骨暴露。
方法:计算机断层扫描证实左EAC骨侵蚀,在没有其他骨坏死危险因素的情况下,诊断为双膦酸盐诱导的骨坏死。管理涉及双膦酸盐停药,普通的听觉厕所,和局部治疗,在6个月内实现完整的耳道上皮化。
结论:MRECO,抗再吸收治疗的罕见并发症,随着老龄化人口中抗吸收性药物使用的增加,预计将会上升。在有当前或先前的抗再吸收治疗史的患者中,无法解释的耳部症状应引起临床关注,提示评估EAC中的暴露骨。提高初级保健提供者对MRECO的认识对于早期诊断和及时管理至关重要。
BACKGROUND: Medication-related ear canal osteonecrosis (MRECO) is a growing concern linked to prolonged anti-resorptive medication use. Despite primary care providers being key prescribers of these medications, there is limited information about MRECO in primary care literature. This article presents a
case of bisphosphonate-induced osteonecrosis of the external auditory canal (EAC), emphasizing the vital role of primary care providers in identifying this rare yet significant side effect of anti-resorptive medication.
UNASSIGNED: A 65-year-old female, on long-term alendronic acid for osteoporosis, presented to primary care with a 2-year history of left-sided ear blockage and itchiness. Despite prolonged topical treatment for ear wax, symptoms persisted, leading to an Otolaryngology referral. Microsuction revealed exposed bone in the left EAC.
METHODS: A computed tomography scan confirmed bony erosion of the left EAC, and in the absence of other osteonecrosis risk factors, bisphosphonate-induced osteonecrosis was diagnosed. Management involved bisphosphonate discontinuation, regular aural toilet, and topical treatment, achieving complete ear canal epithelialisation within 6 months.
CONCLUSIONS: MRECO, a rare complication of anti-resorptive therapy, is anticipated to rise with increasing antiresorptive medication use in the ageing population. Unexplained ear symptoms in those with a history of current or prior anti-resorptive therapy should raise clinical concern, prompting evaluation for exposed bone in the EAC. Raising awareness of MRECO among primary care providers is crucial for early diagnosis and timely management.