Otologic manifestations in
chronic lymphocytic leukemia (CLL) are common presentations. However, temporal bone
metastasis is rarely described as a sign of relapsing CLL. A 65-year-old male diabetic patient known to have CLL on remission presented to the outpatient otolaryngology clinic with a one month history of progressive bilateral
otalgia and right otorrhea, despite multiple courses of
antibiotics. He was admitted with suspicion of malignant
otitis externa. Left ear showed large hemorrhagic
bullae on the posterior segment of tympanic membrane. Left sided
facial paralysis developed on the third day of admission. Full recovery of
facial paralysis is achieved by 10 days course of corticotherapy. Histological examination of middle ear tissue biopsy showed infiltration by monotonous small lymphoid cells, showing round nuclei, condensed
chromatin suggestive of CLL. Although rare, unusual otologic manifestations should raise the suspicion of a temporal bone
metastasis as a sign of relapsing CLL.