What happened, in summary

A 77-year-old man developed several weeks of left-sided hearing loss, ear pain, and a red mass filling the external auditory canal. Imaging also found a mass in the right upper lung, a pancreatic lesion, and disease involving bone. Biopsies from the ear-canal, lung, and pancreatic lesions confirmed small cell lung cancer arising from the lung, making this a Stage IV presentation.

He received carboplatin and etoposide chemotherapy, with zoledronic acid for bone metastases. The treatment reduced the metastatic tumors, including the lesions in the external auditory canal and middle ear. As the tumor shrank, his hearing improved enough that conversations became easier to understand, and his ear pain improved enough for opioid pain treatment to be stopped.

Despite this initial response, the cancer remained advanced. He died 15 months after diagnosis. At autopsy, the external auditory canal lesions had resolved grossly, showing that this unusual metastatic site had responded strongly to chemotherapy even though the overall disease ultimately remained life-limiting.