Abstract: Introduction: osteonecrosis of the external auditory canal (OEAC) is a rare and poorly recognized skeletal complication of antiresorptive therapy. Case report: we present the case of a 57-year-old woman with osteoporosis on a 4-year regimen with alendronate. She was referred to an otolaryngologist for the removal of a cerumen plug in her left ear. Otoscopy revealed ulcerated and painless regions on the floor of both external auditory canals, which were consistent with osteonecrosis. Discussion: although OEAC is an uncommon skeletal complication of antiresorptive use, the development of localized ear symptoms should alert physicians on this rare clinical entity, prompting them to request an otolaryngological evaluation for early diagnosis and treatment.

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