Tick in Ear – September 26, 2024
A 63-year-old male veteran presents to the veterans affairs (VA) emergency department with concerns for painless decreased hearing in one ear. The following image is obtained.
What is the next step in management?
- Urgent consultation to otolaryngology (ENT)
- Exploration of the foreign body with forceps
- Flushing of the foreign body with saline
- Initiation of antibiotics
Answer 1. Urgent consultation to otolaryngology (ENT)
The veteran has a tick attached in his external auditory canal.
On the initial exam, the pathology shown in the image was unclear. The appearance was inconsistent with an infection such as acute otitis media (AOM). Flushing was dismissed as the object appeared attached to the eardrum or ear canal. Exploration of the foreign body with forceps was considered but dismissed based on the high risk of probing an unknown object near the ear drum. Otolaryngology (ENT) was e-consulted with this image and thought it might be a polyp. A consultation appointment with ENT was made for the veteran.
The veteran returned to the VA about a week later for a different issue. At that visit, he reported to medical staff that a fully engorged tick had crawled out of his ear the prior day.
On re-evaluation of the image, it clearly shows congealed blood adjacent to the “polyp” consistent with a tick attachment.
Here is a video of the exam with the tick present.
