Correspondence

In-Flight Audio Otitis

N Engl J Med 1994; 330:943March 31, 1994

Article

To the Editor:

A 50-year-old male physician requested an evaluation for mild discomfort in the left ear that had recurred intermittently for a week. Four days before the visit he had difficulty clearing water from his left ear after swimming. There was no history of trauma, otorrhea, or hearing loss. In the previous month he had flown to Europe and back without any symptoms related to the ear.

Examination of the external portion of the left ear revealed a spongy pale-tan mass that completely filled the ear canal. A small forceps easily removed the mass in one piece, a cylinder (12 mm long and 5 mm in diameter) that appeared to be made of soft foam rubber. Otoscopy revealed erythema of the ear canal but no abnormality of the tympanic membrane. The patient vigorously denied inserting any foreign materials or instruments into his ear, but he was unable to recognize or explain the cylinder that had been found there. His ear symptoms and the erythema gradually disappeared over the following week.

Shortly after this visit, one of us flew on two domestic flights that offered in-flight audio entertainment through an individual headset. A foam-rubber earpiece on the headset was noted to contain a loose cylinder measuring 12 by 5 mm that precisely matched the object withdrawn from the patient's ear. Inspection of other headsets, each sealed in a clear plastic bag, showed that three of four included one or two of these same foam cylinders positioned loosely within an earpiece. These domestic flights involved the same major airline that the patient had used to fly to Europe. We have identified a probable source of foreign bodies in the ear associated with the use of in-flight headsets.

Henry S. Kahn, M.D.
Sandra D. Maryman, M.D.
Emory University School of Medicine, Atlanta, GA 30303-3219