Abstract
An 11-year-old girl with chronic otitis media with effusion was brought to the office for evaluation of a hearing loss accompanied by a popping sound in both ears. She had undergone four previous myringotomies and ventilation tube placements, and on each occasion her hearing had improved. Audiometry demonstrated a bilateral conductive hearing loss, with air-bone gaps of 25 dB in the right ear and 15 db in the left ear. An antibiotic was administered.
On subsequent follow-up, patient's hearing in the right ear had improved, but the conductive hearing loss on the left had persisted. An otoscopic examination of the left ear revealed an interesting incidental finding: a tick-like insect of unknown species attached to the tympanic membrane (figure). Tympanosclerosis at the site of a previous ventilation tube placement was also seen. The patient said she did not remember any event that could be associated with an insect entering her ear, and she had not heard any fluttering sounds or experienced any pain.
A 4% lidocaine and epinephrine solution was used to submerge the insect and anesthetize the area. The insect was easily suctioned out after 5 minutes. The patient experienced no discomfort at all.
Antonelli et al reported that 14% of all otic foreign bodies were insects; 78% of these were cockroaches. 1 They performed a rather detailed test-tube study of the insecticidal activity of 17 common reagents found in otolaryngology clinics. They placed 10 different types of insects into each preparation. They found that none of the insecticide solutions was effective against ticks.
Figure. Otoscopy shows the insect attached to the tympanic membrane and tympanosclerosis at the site of a previous ventilation tube placement.
In our case, we used lidocaine with epinephrine not only to drown the insect but also to allow for a painless extraction. At the most recent follow-up, the patient had demonstrated no evidence of tick- or insect-borne illness.