Gout in the middle ear?

Gout is commonly involved in the first metatarsophalangeal joint followed by tarsal joints, ankle, knee, wrists and finger joints but, bizarrely, it can also manifest in the middle ear, as this case study shows.

The 34-year-old man with no history of joint pain presented with complaints of recurrent otorrhea, and hearing loss for several months. An otoscopic examination of the left hear revealed subtotal tympanic membrane perforation.  White middle ear plaques were also detected.