Case of the Month #23: Ear Pain by Dr Lorraine de Gray
The ENT surgeon had diagnosed osteoradionecrosis of the external auditory meatus secondary to the radiotherapy that Mr P had undergone some months ago.
Osteoradionecrosis results from the damaging effects of radiotherapy. Although an uncommon side effect of radiation treatment for cancers arising in the mouth, the oropharynx and the paranasal sinuses, when it occurs, osteoradionecrosis can lead to very challenging pain to manage as well as significant adverse effect on the person’s quality of life.
Osteoradionecrosis can at times be managed surgically, by debridement, but in Mr P’s case, this was ruled out as his generalised frailty made him too high a risk for a general anaesthetic. There was not thought to be an option for managing the debridement under local or regional anaesthesia. He was therefore referred to the Pain Clinic after being prescribed a course of antibiotics to treat any underlying infection associated with the necrosis.
How would you manage this patient?