Osteonecrosis of the External Auditory Canal Associated With Oral Bisphosphonate Therapy

Salzman, Richard; Hoza, Jiří; Peřina, Vojtěch; Stárek, Ivo

doi:10.1097/mao.0b013e31827ca34d

Cited by 24 publications

(23 citation statements)

References 20 publications

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“…However, in the presence of extensive soft tissue involvement, microbial cultures may identify coexisting oral pathogens and enable the selection of an appropriate antibiotic regimen. Interestingly, although ONJ is exclusive to the jaws by definition, it should be noted that osteonecrosis of the external auditory canal in patients on BP therapy has also been reported …”

Section: Resultsmentioning

confidence: 99%

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Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus

Khan

Morrison

Hanley

et al. 2014

Journal of Bone and Mineral Research

1,075

1,033

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This work provides a systematic review of the literature from January 2003 to April 2014 pertaining to the incidence, pathophysiology, diagnosis, and treatment of osteonecrosis of the jaw (ONJ), and offers recommendations for its management based on multidisciplinary international consensus. ONJ is associated with oncology-dose parenteral antiresorptive therapy of bisphosphonates (BP) and denosumab (Dmab). The incidence of ONJ is greatest in the oncology patient population (1% to 15%), where high doses of these medications are used at frequent intervals. In the osteoporosis patient population, the incidence of ONJ is estimated at 0.001% to 0.01%, marginally higher than the incidence in the general population (<0.001%). New insights into the pathophysiology of ONJ include antiresorptive effects of BPs and Dmab, effects of BPs on gamma delta T-cells and on monocyte and macrophage function, as well as the role of local bacterial infection, inflammation, and necrosis. Advances in imaging include the use of cone beam computerized tomography assessing cortical and cancellous architecture with lower radiation exposure, magnetic resonance imaging, bone scanning, and positron emission tomography, although plain films often suffice. Other risk factors for ONJ include glucocorticoid use, maxillary or mandibular bone surgery, poor oral hygiene, chronic inflammation, diabetes mellitus, illfitting dentures, as well as other drugs, including antiangiogenic agents. Prevention strategies for ONJ include elimination or stabilization of oral disease prior to initiation of antiresorptive agents, as well as maintenance of good oral hygiene. In those patients at high risk for the development of ONJ, including cancer patients receiving high-dose BP or Dmab therapy, consideration should be given to withholding antiresorptive therapy following extensive oral surgery until the surgical site heals with mature mucosal coverage. Management of ONJ is based on the stage of the disease, size of the lesions, and the presence of contributing drug therapy and comorbidity. Conservative therapy includes topical antibiotic oral rinses and systemic antibiotic therapy. Localized surgical debridement is indicated in advanced nonresponsive disease and has been successful. Early data have suggested enhanced osseous wound healing with teriparatide in those without contraindications for its use. Experimental therapy includes bone marrow stem cell intralesional transplantation, low-level laser therapy, local platelet-derived growth factor application, hyperbaric oxygen, and tissue grafting.

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Section: Resultsmentioning

confidence: 99%

“…Interestingly, although ONJ is exclusive to the jaws by definition, it should be noted that osteonecrosis of the external auditory canal in patients on BP therapy has also been reported. (40)(41)(42)(43)(44)(45)(46)…”

Section: Stagingmentioning

confidence: 99%

Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus

Khan

Morrison

Hanley

et al. 2014

Journal of Bone and Mineral Research

1,075

1,033

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“…ORL, 2019, 10, 4, 295-303 ser un factor de riesgo más importante incluso que la forma de administración. Los estudios más recientes, dividen los BFS en dos clases: nitrogenados (tanto orales como iv) y no-nitrogenados (solo orales) [8,9]. Son empleados como parte del tratamiento de la enfermedad de Paget, hipercalcemia tumoral, mieloma múltiple y metástasis óseas, entre otras.…”

Section: Discussionunclassified

“…El desarrollo de osteonecrosis mandibular está en relación con la potencia del BFS empleado [5]. Existen muy pocos casos publicados de osteonecrosis mandibular en pacientes consumidores de BFS no-nitrogenados en comparación con los más de 3000 casos publicados de los BFS nitrogenados como el alendronato, pamidronato y zoledronato [5,9,10].…”

Section: Discussionunclassified

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Osteonecrosis de conducto auditivo externo secundaria a bifosfonatos. Revisión sistemática

et al. 2019

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Conflicto de intereses: Los autores declaran no tener conflictos de intereses Imágenes: Los autores declaran haber obtenido las imágenes con el permiso de los pacientes Política de derechos y autoarchivo: se permite el autoarchivo de la versión post-print (SHERPA/RoMEO) Licencia CC BY-NC-ND. Licencia Creative Commons Atribución-NoComercial-SinDerivar 4.0 Internacional Universidad de Salamanca. Su comercialización está sujeta al permiso del editor RESUMEN: Introducción y objetivo: La osteonecrosis benigna del conducto auditivo externo (CAE) es un efecto secundario bastante desconocido del tratamiento con bifosfonatos (BFS). Nuestro objetivo es describir la forma de presentación y el manejo terapéutico de los casos descritos en la literatura. Método: Se realizó una revisión sistemática de la literatura de los casos de osteonecrosis del CAE secundaria a BFS desde septiembre 2003 a febrero 2019. Se siguieron los criterios PRISMA evaluando las bases de datos PubMED. Resultados: Se han identificado 7 estudios que incluyen un total de 17 pacientes con osteonecrosis del CAE. El 76% fueron mujeres y el 24% restante varones, con edades comprendidas entre 51 y 89. El tiempo de evolución hasta la aparición de complicaciones osciló entre 15 meses y 20 años. La forma de presentación fue la úlcera sobreinfectada con exposición ósea unilateral en 41% de los casos. La zona de aparición inicial fue el suelo del CAE en el 100%. Se realizó tomografía axial computarizada al 47% de los casos observando signos de necrosis ósea; y dos biopsias con resultado de osteomielitis. 9 pacientes (53%) fueron tratados con éxito con antibioterapia ± corticoides tópicos, mientras que los 8 restantes (47%) precisaron tratamiento quirúrgico además de la retirada de BFS. Discusión/Conclusiones: La osteonecrosis de CAE es un efecto secundario muy infrecuente del uso de BFS. La forma de presentación más común es la OSTEONECROSIS DE CONDUCTO AUDITIVO EXTERNO SECUNDARIA A BIFOSFONATOS. REVISIÓN SISTEMÁTICA DE LA LITERATURA LÓPEZ-SIMÓN E ET AL Ediciones Universidad de Salamanca / [ 296 ]Rev. ORL, 2019, 10, 4, 295-303

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Imaging of the Temporal Bone in Hearing Loss

Warner¹,

Dziedzic²,

Lingam³

et al. 2021

Head and Neck Imaging

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Osteonecrosis of the External Auditory Canal Associated With Oral Bisphosphonate Therapy

Cited by 24 publications

References 20 publications

Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus

Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic Review and International Consensus

Osteonecrosis de conducto auditivo externo secundaria a bifosfonatos. Revisión sistemática

Imaging of the Temporal Bone in Hearing Loss

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