Letters to the Editor
An Uninvited Guest in the Ear
Am Fam Physician. 2000 May 1;61(9):2606-2611.
to the editor: Spring is the best season in Tokyo, with cherry trees blossoming beautifully after the winter rest. However, many uninvited guests are also awakening from their sleep.
This spring, a 40-year-old man was admitted to our clinic with a sudden onset of tinnitus and severe pain in the left ear. The tinnitus and pain occurred simultaneously while the patient was sleeping. On examination, we found a bug stuck in the external auditory canal (see the accompanying figure). The bug seemed to be struggling to reach the patient's eardrum. We applied a topical anesthetic (4 percent lidocaine), which had a desirable effect on the patient and the bug.1–4 It was immobilized and easily removed with forceps.
The bug was a cockroach. We had seen some reports like this one.1–5 For anatomic reasons, a cockroach is generally unable to back out of the external auditory canal. The more it tries to back out, the more stuck it becomes. In this case, the use of a topical anesthetic decreased the patient's symptoms and also removed the bug's confusion.
After removal of the bug, the patient's symptoms disappeared completely. We informed him that a “pretty insect” had been stuck in his ear. To prevent adverse psychologic reaction, we did not tell him it was a cockroach. The patient is now able to sleep comfortably. What about the cockroach? It is also sleeping, in formalin.
1. Schittek A. Insect in the external auditory canal—a new way out. JAMA. 1980;243:331.
2. O'Toole K, Paris PM, Steward RD, Martinez R. Removing cockroaches from the auditory canal: controlled trial. N Engl J Med. 1985;312:1197.
3. Cantrell H. More on removing cockroaches from the auditory canal. N Engl J Med. 1986;314:720.
4. Leffler S, Cheney P, Tandberg D. Chemical immobilization and killing of intra-aural roaches: an in vitro comparative study. Ann Emerg Med. 1993;22:1795–8.
5. Warren J, Rotello LC. Removing cockroaches from the auditory canal: a direct method. N Engl J Med. 1989;320:322.
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