Sunitinib and sorafenib are targeted therapies against tyrosine kinase activity. An uncommon side effect is osteonecrosis of the external auditory canal.
Sutinib is a receptor tyrosine kinase inhibitor used to treat renal cell carcinoma and GI stromal tumors.
Sorafenib is a protein kinase inhibitor that can affects many protein kinases.
Features:
(1) ear pain (otalgia)
(2) otorrhea
(3) imaging findings show changes consistent with osteonecrosis of the external auditory canal that may extend further into the temporal bone
(4) biopsy shows necrotic bone and inflammation
Differential diagnosis:
(1) osteonecrosis related to bisphosphonate therapy, which can also cause osteonecrosis of the external auditory canal
(2) otitis externa with or without osteomyelitis
(3) radiation necrosis
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