Removal was attempted using a forceps under endoscopic guidance, but the procedure was abandoned as the patient could not tolerate the pain. The tick was partly covered by ear discharge. Routine endoscopic examination showed a tick in the external ear canal near the tympanic membrane. Post removal otoscopy showed intact tympanic membrane with minimally inflamed external auditory canal.Ī 15-year-old Malay girl who was under regular follow-up for chronic suppurative otitis media presented to the otorhinolaryngology clinic with one-week history of active ear discharge associated with mild otalgia. Removal of the tick was performed under microscope guidance using a Tilley forceps. Gentle suction was done to clean the fecal material together with residual ointment. Topical 10% cocaine ointment was applied into the left ear canal for five to ten minutes. On left ear endoscopic examination, there was an engorged tick at the posterior wall of external auditory canal (Figure 3). Patient was brought to the otorhinolaryngology clinic and had otalgia on clinical examination. Her parent gave history of travelling to rural areas where patient had contact with domestic animals. Facial paralysis and otalgia had resolved without complications.Ī 3-year-old girl presented to the emergency unit with a three-day history of left ear pain in association with easy irritability and reduced oral intake. On follow up at otorhinolaryngology clinic, patient showed significant improvement after four weeks. Oral steroids were continued for two weeks to reduce nerve inflammation and were subsequently tapered off. Patient was prescribed olfloxacin 0.3% eardrops with oral prednisolone 40 mg once daily. The debris of fecal material was cleared with gentle suction. Tick was carefully removed with crocodile forceps under endoscopic guidance after instilling 10% cocaine eardrops. The right ear appeared normal and no foreign body was seen in the ear canal. The visualized tympanic membrane was intact. Otoscopic examination revealed an engorged tick in the mildly inflamed left ear canal (Figure 2). This facial nerve palsy was graded as House-Brackmann Grade 3 (Figure 1). The patient exhibited loss of wrinkles over left forehead, drooping of left corner of mouth and inability to completely close her left eye. Clinical examination revealed a thin female with obvious facial asymmetry. There was history of contact with domestic animals around the house prior to clinical presentation. There was no history of ear discharge or ear bleed. The facial weakness slowly developed over her left face during the two days after the onset of ear pain. Pain was associated with left facial weakness.
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We report three cases of intra-aural tick with different clinical presentations.Ī 25-year-old Malay woman presented to the emergency department with complaint of left ear pain for three days. A neglected otoacariasis can result in complications such as ear infection, cranial nerve involvement and even death. The clinical presentation varies, although the commonest being an intolerable otalgia. It is a common phenomenon especially involving insects and arthropods such as tick. Otoacariasis is the presence of a live animal in human ear.
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Keywords: Otoacariasis Otalgia Complication We present three cases of otoacariasis with multiple clinical presentations. Other than otalgia, there are numerous other complications that can result from otoacariasis ranging from bleeding to nerve paralysis and even fatalities. Both adult and pediatric patients can present with otoacariasis and most of them will come with a complaint of otalgia. Presence of ticks or mites in the external auditory canal is known as otoacariasis. Norhafiza Mat Lazim 1, Irfan Mohamad 1, Mohammed Khairi Mohammed Daud 1, Rosdan Salim 1ġ Department of ORL-HNS, School of Medical Sciences, University Sains Malaysia, Penang, Malaysia