This case is reported in order to demonstrate the importance of detailed clinical analysis, including evaluation of personal and family history, in the differential diagnosis of sudden sensorineural hearing loss.

A 50-year-old woman presented with a sudden onset of sensorineural hearing loss in her right ear. She had experienced three previous episodes of sudden sensorineural hearing loss in her left ear, at the ages of 35, 48 and 50 years. She also reported suffering two strokes with left hemiparesis due to fibromuscular dysplasia of her right internal carotid artery. A positive family history of stroke among maternal relatives suggested autosomal dominant inheritance. The patient's personal and family history suggested a rare cause of sudden sensorineural hearing loss, for which alternative therapeutic modalities may be applicable in selected cases.

Careful follow up of any patient with sudden sensorineural hearing loss and evaluation of their personal and family history is essential, in order to uncover evidence of rare underlying causes of sudden sensorineural hearing loss. For patients with such rare diagnoses, alternative therapy and surveillance modalities may be useful in disease management, depending on pre-existing pathology. Those patients should be managed via a multidisciplinary approach, including genetic counselling, in order to achieve the best possible outcome.

To present a rare case of rectal adenocarcinoma metastasising to the external auditory canal, in a patient in whom computed tomography staging of the abdomen, chest and pelvis was clear for metastatic disease.

Case report and review of the literature.

Metastatic tumours to the external auditory canal are rare, with rectal adenocarcinoma being one of the rarest. However, it is important that the external auditory canal is regarded as a potential site for metastasis, even when computed tomography staging is clear. Metastatic tumour should be included in the differential diagnosis of a patient presenting with an ear mass.