Benign idiopathic osteonecrosis of the temporal bone – a case report.

Introduction: Benign idiopathic osteonecrosis of the temporal bone is a rare disease with an unknown prevalence. It is characterized by bone necrosis of unknown etiology within the temporal bone. Usually limited to the external auditory canal, the lesions may present with a sensation of fullness in the ear, chronic itching, ear pain, tinnitus or hearing loss. In some patients, the disease remains asymptomatic.Objectives: The aim of this study is to present a case of idiopathic temporal bone necrosis, including a discussion of the disease course, diagnostic process, differential diagnosis, and treatment.Discussion: The differential diagnosis of this rare condition should include pathologies such as malignant otitis externa, obstructive keratosis, external auditory canal cholesteatoma, and neoplastic processes. Therapeutic management involves debridement of necrotic bone fragments from the ear canal. In cases of insufficient response or extensive involvement, surgical intervention with defect reconstruction and hyperbaric oxygen therapy may be necessary. In the presented case of a 71-year-old man with localized necrosis, conservative treatment resulted in complete healing of the external auditory canal.Conclusions: Due to the unclear etiology and lack of standardized treatment guidelines, therapeutic management should always be individualized and based on the extent of the lesions and clinical symptoms. In asymptomatic cases with limited involvement, a minimally invasive approach combined with further observation is recommended.