Images in Clinical Medicine

A Tickling in the Ear

Andreas Arnold, M.D., and Wolfgang Arnold, M.D.

N Engl J Med 2012; 367:e17September 20, 2012DOI: 10.1056/NEJMicm1114612

• Slide

Article

A 63-year-old man presented with acute pruritus and bubbling tinnitus in his right ear, without hearing loss. Otoscopy revealed a bug anchored to the anterosuperior portion of the right tympanic membrane. The bug was removed by suction after a topical anesthetic agent was applied to the patient's ear. The tinnitus resolved immediately. Aside from mild hyperemia, no visible damage to the tympanic membrane was observed. Insects can be found as foreign bodies in the outer ear canal. The differential diagnosis for acute tinnitus and pruritus without hearing loss should prompt evaluation for a foreign body in the outer ear canal. Two weeks after presentation, this patient had a normal tympanic membrane.

Andreas Arnold, M.D.
Bern University Hospital, Bern, Switzerland
andreas.arnold@insel.ch

Wolfgang Arnold, M.D.
Technical University of Munich, Munich, Germany

This article was updated on January 3, 2013, at NEJM.org.