Maggots in the Ear After Trip to Peru

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Adventurous international travelers have to worry about malaria and safe drinking water, but for one 27 years old British woman, she also had to contend with a maggot infestation in the ear after a trip to Peru.

It was not quite the 57 maggots found in one Illinois woman, but apparently this traveler recalled walking thru a fly swarm in Peru and that one fly did briefly enter her ear canal. However, it was enough for the fly (New World Screwworm fly) to lay its eggs causing maggots to hatch and slowly eat away her ear canal causing severe pain and scratching sounds within her head.

Surgery was required to remove the maggots. Less aggressive attempts to remove would only cause the maggots to burrow even deeper into her ear/head. Potential damage from the maggots include permanent hearing loss for obvious reasons, but also facial paralysis and taste changes given the facial nerve and chorda tympani (taste nerve) pass through the ear as well.

Fortunately, all maggots were successfully removed without any permanent damage.

Source:

British Woman Discovers Flesh-Eating Maggots Inside Her Ear. Medical Daily 7/16/13.

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Some Facts About Q-Tips and Ears

In this week's episode of "Girls" (Season 2; Episode 9 "Girls Gets Dark"), Hannah grappling with OCD, inserted a Q-tip deep into her ear canal and "heard air hiss out the hole" due to perforating her eardrum.

Although this scene came out of a TV show, this scenario is not uncommon and results in many ENT office visits every month for not only eardrum perforations, but bleeding due to trauma to the ear canal skin.

Some facts about Q-tips as it relates to the ear...

It should never be used to clean earwax within the ear canal. In fact, on Unilever's website (the maker of Q-tips), the company explicitly states that Q-tips should only be used to "gently around the outer ear, without entering the ear canal." [link]

In fact, the word "ear" appears less than a dozen times on the entire Q-tip website.

Apparently, Q-tips are meant for many other uses beyond ears which play only a very small role in the world of Q-tips.

• Cleaning tiny spaces in ventilator grates
• Applying polishes to silverware
• Dust picture frames
• Clean keyboards and the computer screen
• Applying wood stain
• Clean tracks and grooves of medicine cabinets
• Clean small compartments of washing machines
etc, etc, etc

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Screwdriver into the Ear of Tennis Star Rafael Nadal

On a more humorous note, take a look at this picture from Sports Illustrated...

As per the caption in SI, it is EXACTLY what it looks like except,

A worker at Madame Tussaud’s puts the finishing touches to a model of Rafael Nadal in London last May. (Kirsty Wigglesworth/AP Photo)

I did want to point out that though a screwdriver inserted into the ear canal may be OK for a wax model, it is not OK for a breathing, living human being.

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Do Ear Candles Actually Remove Earwax? [video]

About once a week, I have a patient who presents to my clinic with a history of ear candling for earwax removal due to clogged ear sensation.

About once a month, I have a patient with ear canal and/or eardrum damage due to using an ear candle in an attempt to remove earwax.

I even have on occasion patients who I thoroughly remove earwax under the microscope, who than go home, perform an ear candle, and inform me of all the "earwax" that I missed.

Well... I've decided to make a video (see below) illustrating how ineffective ear candling is in removing earwax as well as how it could be even harmful. The other aspect of this educational video is to show how misleading ear candling is when it comes to earwax.

Please note that we are aware that the  "official" way to use an ear candling is small end down into the ear, but for this video, we have elected to use it the way most "lay" public would (small end up).

[SPOILER ALERT!!! A burning ear candle actually creates debris that looks like earwax. As such, an ear candle "works" whether it is in the ear or not.]

References:
Ear candles: Efficacy and safety. Laryngoscope 106 (10): 1226–9.

Ear candling: Should general practitioners recommend it? Can Fam Physician 53 (12): 2121–2. PMC 2231549. PMID 18077749.

Ear candles can be purchased on Amazon.com for you to "experiment" with.

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57 Maggots Removed from Woman's Ear

92 years old woman with Alzheimer's was found to have 57 maggots in her ear sparking a lawsuit. Read more from media reports.

Beyond the gross factor and questions regarding how this was allowed to happen, this story does bring up some interesting teaching points and the medicinal properties of "maggot therapy".

Media reported the patient suffered from earwax build-up and had "an enlarged ear canal from surgery performed decades earlier."

This  surgery was most likely a canal-wall-down tympanomastoidectomy often performed for a benign ear tumor called cholesteatoma or a severe chronic draining ear. This surgery essentially removes all the bone from behind the ear (mastoid) and ear canal back wall. Depending on how aggressive the surgery, the eardrum and middle ear bones (malleus, stapes, and incus) may also be removed.

With such surgery, the ear canal now 2-3 times larger than before, is prone to developing earwax impaction and requires surgical debridement or removal every 4-6 months for the rest of the patient's life.

If surgical debridement is not performed regularly in such patients, infection may set in.

With such infection, ear drops can be used as described in the story, but such treatment is bound to fail until ear canal debridement of all earwax is first performed.

What I suspect is that this poor patient did not get her ear cleaned out regularly resulting in infected earwax. A fly noting the foul cesspool located in a dark, humid environment of this enlarged ear canal probably thought this the perfect place to lay eggs and allow a maggot infestation to occur.

Gross, horrid, and astounding I know...

However, medicinal maggot therapy is actually used in hospitals... Why?

Because maggots are apparently WAY better than a surgeon in certain situations at removing dead infected tissue with or without antibiotics.

It is entirely possible that given time, the maggots might have cleaned and removed the infection that was probably present in this patient's ear. However, unlike medical-grade maggots which are "sterilized" prior to use, "natural"maggots probably harbor other microbes that could cause a secondary infection.

Such medicinal maggots can be purchased for wound control with a prescription. Monarch Labs is the exclusive USA supplier of medicinal maggots which the FDA considers a "medical device."

Here is a video produced by National Geographic on maggot therapy.

Source:
92-year-old has 57 maggots removed from ear, family sues nursing home. CBS News 11/30/12

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Kissing the Ear Can Cause Permanent Hearing Loss

MSNBC reported 3/29/12 about a phenomenon called cochlear ear-kiss injury. This condition is when hearing loss occurs after a person kisses someone else over the ear, usually a mom over a baby's or child's ear.

Right after the kiss, a person can suffer from immediate and potentially permanent hearing loss along with other symptoms including ringing, sensitivity to sound, sound distortion, and aural fullness.

How or why does this occur?

With a kiss, a strong suction is created within the ear canal that pulls on the eardrum which tugs on the middle ear bones that can lead to turbulence within the inner ear.

Infants are particularly susceptible to this condition given their ear canals are SO small and the suction created by an adult kiss over the ear can be so strong.

There are other variations of this type of ear/hearing injury.

Barotrauma of the ear can lead to similar type issues due to sudden pressure changes from flying, parachute jumping, diving into water, SCUBA, snorkeling, etc.

Getting slapped over the ear can do the same thing as cochlear ear-kiss injury, but in reverse. Rather than suction from a kiss creating strong negative pressure within the ear canal, a slap over the ear creates sudden strong positive pressure.

At times, such pressure changes can get so severe that the eardrum can rupture.

Source:
Innocent 'kiss of deaf' can cause permanent hearing loss. MSNBC 3/29/12

The kiss of deaf: Four-year-old's big smooch left her mom with partial hearing loss. Newsday. June 7, 2008

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