Letters to the Editor

An Uninvited Guest in the Ear



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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.14 It was immobilized and easily removed with forceps.

FIGURE.

A bug stuck in the external auditory canal. The bug seemed to be struggling to reach the patient's eardrum.

View Large


FIGURE.

A bug stuck in the external auditory canal. The bug seemed to be struggling to reach the patient's eardrum.


FIGURE.

A bug stuck in the external auditory canal. The bug seemed to be struggling to reach the patient's eardrum.

The bug was a cockroach. We had seen some reports like this one.15 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.

REFERENCES

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.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.



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