Management of an Unusual Middle Ear Foreign Body

Presentation: A 42-year-old male was recently fitted for occupational ear molds to protect him from excessive noise exposure at work and further hearing loss. During the fitting, he experienced severe, sudden otalgia and vertigo and complained that hearing loss in the left ear, his better-hearing ear, had worsened. The dizziness resolved quickly, but the discomfort and hearing loss did not. He presented five days later with complaints of hearing loss and intermittent drainage but denied disequilibrium or vertigo.

The patient reported a history of multiple bilateral ventilation tubes as a child, a known right retracted tympanic membrane (TM) and bilateral hearing loss. An audiogram showed a right severe mixed hearing loss, with 74 percent word recognition, which was stable from prior testing. His left ear had new moderate-to-severe mixed hearing loss, with 84 percent word recognition. Tympanogram was type B bilaterally. Micro-otoscopy of the left ear revealed myringosclerosis, a healing traumatic TM perforation and a foreign body in the medial aspect of the ear canal extending through the anterosuperior tympanic membrane into the middle ear space.

—Submitted by by Joshua R. Mitchell, MD, Stanley Pelosi, MD, and Georges B. Wanna, MD, department of otolaryngology-head and neck surgery and The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, Tenn.

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