Metastatic renal cell carcinoma presenting in the external auditory canal

A 57-year-old male previously in good health presented to his primary care physician with sudden onset of left-sided subjective hearing loss and aural fullness. Examination revealed a small polypoid, friable mass in the left external auditory canal. Excisional biopsy findings were consistent with metastatic renal cell carcinoma, and the patient subsequently was referred to our institution, where further diagnostic workup, including renal biopsy, confirmed the diagnosis. Physical examination at that time revealed regrowth of the aural mass, which now completely occluded the external auditory canal and protruded from the meatus (Fig 1). Audiogram revealed a mixed profound hearing loss in the left ear, and MRI of the internal auditory canals and brain demonstrated multiple intracranial metastasis with erosion of middle-ear structures.