On initial exam, the pathology shown in the image was unclear. Otolaryngology (ENT) was e-consulted with this image and thought it might be a polyp. Exploring the lesion was considered but quickly discarded. 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.