Otorrheacan result from middle ear discharge with tympanic membrane perforation, external ear canal pathology, skull injury and other serious diseases in trauma and immunocompromised patients.1Thorough investigation is warranted in cases without improvement after treatment. We present a case where fibrous dysplasia was the underlying cause and discuss its treatment.

CASE REPORT
A 41-year-old farmer man consulted at our ENT Outpatient Clinic with a 1-year history of clear, non-foul-smelling discharge from his left ear, associated with intermittent pounding ear pain. A hard immobile nontender prominence was noted over the patient’s left temporal area. (Figure 1) He was initially treated for chronic suppurative otitis media for 3 months. Severe ear pain was noted,
10/10 on pain scale, squeezing in character, radiating to the left temporal and parietal area associated with progressive hearing loss and ear fullness. Plain CT scans revealed a combined lytic and ground glass expansile lesion involving the left occipital, mastoid, and petrous temporal bone and portion of the parietal bone obliterating the external auditory canal and middle ear. (Figure 2)

On physical examination, a hard immobile nontender prominence was noted over the patient’s left temporo-parietal area. No facial asymmetry or numbness was noted. On otoscopy, there was a skin-colored round smooth hard immobile nontender mass in the external auditory canal with non-foul smelling whitish to yellowish purulent discharge. A Weber tuning fork test lateralized to the left and a Rinne test revealed air conduction < bone conduction on the left, and air conduction > bone conduction on the right.

The patient was admitted with an impression of chronic suppurative otitis media, left; to consider fibrous dysplasia vs. tuberculosis. Aerobic culture of ear discharge revealed no growth. Canal down mastoidectomy was done. Intraoperative findings revealed granulomatous and cartilaginous lesions on the mastoid and temporal bone. (Figure 3) There were aural polyps and cholesteatoma with the ossicles apparently eroded by the lesion. (Figure 4) Temporal bone fluid was sent for GeneXpert MTB/RIF while the surgical specimen was sent for histopathology. GeneXpert MTB/RIF revealed negative results for tuberculosis. Final histopathology results showed fibrous dysplasia.

Human ; Male ; Adult: 25-44 Yrs Old

Objective: To determine the profile of patients with oral cavity cancer seen at the Ear, Nose and Throat – Head and Neck Surgery (ENT-HNS) Department of the Bicol Medical Center from January 2018 to December 2020. Methods: Design: Retrospective review of records Setting: Tertiary Government Training Hospital Participants: Medical records of patients with oral cavity lesions with malignant biopsy results seen at the Bicol Medical Center Department of ENT-HNS from January 2018 to December 2020. Results: Records of 42 patients were included, 30 (71%) male; 12 (29%) female with the mean age of 62 ± 10.02 (range 34 to 80 years old). Squamous cell carcinoma was the most common histopathologic diagnosis (38/42; 91%), mostly affecting the anterior tongue (16/42; 38%) and buccal regions (14/42; 33%). Most tumors were in advanced stages: 25/42 (59%) in stage IVA; 7 (17%) in stage IVB. A total of 61% (17) of 28 oral cavity cancer patients with recorded risk factors practiced a combination of two or three high risk habits (betel nut chewing, tobacco smoking, alcoholic beverage intake) and a third practiced all three (10/28; 36%). Conclusion The profile of oral cavity cancer patients in our study is different from the reported profiles in Asia and European and US counterparts. Our profile patient is a married male farmer in the 7th decade of life with poor dental hygiene and advanced stage IV squamous cell carcinoma of the tongue and buccal region, and combined habits of regular alcoholic beverage drinking, chronic tobacco smoking, and/or betel nut chewing, who lives in coastal or mountainous communities where access to health care may be limited.
squamous cell carcinoma