A 54-year-old patient presented with hearing loss for three weeks and tinnitus on the left. Ear microscopy showed polypous tumor in the right ear canal and similar obliterating tumor on the left. The patient also reported back pain and hyperhidrosis. The histological processing of the biopsies obtained from the auditory canals indicated infiltrates of small-cell neuroendocrine carcinoma. FDG-PET whole-body computed tomography (FDG, fluorodeoxyglucose; PET, positron emission tomography) showed malignancy-typical metabolism in multiple locations throughout the body without evidence of primary disease. Therefore, the diagnosis of disseminated unknown primary tumor (CUP, "cancer of unknown primary") of small cell neuroendocrine carcinoma was made. A platinum-etoposide chemotherapy regimen was quickly initiated. Seven months after the diagnosis, the patient died of liver failure with progressive metastasis. This case report shows that in the case of unclear tumors in the area of the ear canal, histological confirmation is always recommended to exclude malignancies. In the differential diagnosis, benign tumors and cholesteatomas include squamous cell carcinomas and basal cell carcinomas. Even supposedly simple hearing loss can have complex cause such as neurodendocrine CUP.
Dr. med. Thea C. Reuter, Prof. Dr. med. Susan Arndt, Dr. med. Till F. Jakob, Department of Otorhinolaryngology, Freiburg University Medical Center, Faculty of Medicine, Albert Ludwig University of Freiburg, thea.charlott.reuter@uniklinik-freiburg.de
Conflict of interest : The authors declare that there is no conflict of interest.
Citation: Reuter TC, Arndt S, Jakob TF: A rare cause of hearing impairment. Dtsch Arztebl Int 2019; 116: 486. DOI: 10.3238 / arztebl.2019.0486a
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