Septic emboli are an unusual cause of sudden sensorineural hearing loss, for which few reports exist in the literature. This paper presents two cases of sudden sensorineural hearing loss, initially considered as idiopathic, but which were caused by septic emboli. Hearing loss in these cases was bilateral, sequential and total. The first patient had mild fever one week prior to their presentation with sudden sensorineural hearing loss; the other patient had no additional symptoms at presentation. These patients were later diagnosed with infective endocarditis, at two and seven months following the sudden sensorineural hearing loss respectively, showing that septic emboli had been the cause of sudden sensorineural hearing loss. Septic emboli should be considered as a possible cause of sudden sensorineural hearing loss in cases of total hearing loss. This form of hearing loss should prompt the otolaryngologist to further investigate for infective endocarditis.

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