A 64-year-old woman with hypertension presented to the otolaryngology clinic with a 4-day history of abnormal sounds in her left ear. On the day of symptom onset, she had awoken to the feeling of a creature moving inside her left ear. Subsequent incessant beating, clicking, and rustling sounds had led to insomnia. On physical examination, a small spider was seen moving within the external auditory canal of the left ear (see video). The molted exoskeleton of the spider was also present. The tympanic membrane was normal. The spider and exoskeleton were removed with the use of a suction cannula placed through an otoscope. In cases of larger spiders or insects in the external auditory canal, instillation of lidocaine or ethanol is recommended for killing the animal before removal in order to prevent excessive movements and subsequent damage to the structures of the ear. However, liquids should not be introduced into the ear if the tympanic membrane has been perforated. After removal of the spider and exoskeleton, the patient’s symptoms immediately abated.
Case report from the New England Journal of Medicine (video at the link).