Tympanic Membrane Involvement of Multiple Myeloma: Report of a Case.

Extramedullary Involvement (EMI) in Multiple Myeloma (MM) is a rare but aggressive entity that usually occurs in advanced or relapsed cases of MM. Although otologic manifestations aren't frequent, they may mimic common inflammatory or neoplastic pathologies and could be a diagnostic challenge for the clinician. Case presentation: A 65-year-old woman with a history of Relapsed Refractory Multiple Myeloma (RRMM) presented at our outpatient Otolaryngology department with a four-month history of right-sided aural fullness and a minor episode of watery otorrhea. Otoscopy revealed an abnormal tympanic membrane lesion, and audiological evaluation showed moderate conductive hearing loss. The rest of the examination was normal. A Computed Tomography (CT) scan showed a soft-tissue mass occupying the tympanic membrane with associated temporal bone erosion. The history of RRMM and otoscopic and CT findings were indicative of EMI. After multidisciplinary consultation with a hematologist and radiologist, systemic therapy for relapsed disease was initiated, with consideration of adjunctive radiotherapy. However, the clinical course of the patient deteriorated and she eventually died due to her multiple comorbidities. Conclusions: EMI of the tympanic membrane is a rare entity, among the few reported cases with otologic involvement and it remains a diagnostic "challenge" because it resembles many other otologic conditions. Careful analysis of imaging findings in combination with the patient's medical history is the key to accurate diagnosis. Early recognition is necessary to guide appropriate management, avoid unnecessary surgical intervention, and enable timely initiation of systemic therapy.