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).
When I see something credited to the New England Journal of Medicine I automatically assume it's from one of the numerous hospitals and medical schools radiating from Boston. But this time I followed the link to discover it was Taiwan, so while I still believe the Journal is reliable, I'll know to check in the future.
ReplyDeletexoxoxoBruce
I totally don't understand your point. The New England Journal of Medicine is the premiere journal for medical news and science. It receives content from worldwide sources and peer-reviews the submissions. Are you suggesting that info written by physicians outside the U.S. is somehow less reliable???
DeleteIf this spider in the ear story had been posted on X or TikTok I would be wondering if it was legit? Coming from the NEJM I trust the source, but not being a regular reader (only when linked by someone) I never wondered where the items originated.
DeletexoxoxoBruce
Oh my. I'm surprised this made the NEJOM, except for the exoskeleton and the great photo, bug in ear removal is a fairly normal procedure in the ED.
ReplyDeleteThis is not from a major article or a case report - it's part of an ongoing "images in clinical medicine" series showcasing clinical photos:
Deletehttps://www.nejm.org/multimedia/images-in-clinical-medicine
Late October, spiders, Halloween, a timely image...
ReplyDeleteThat's likely the reason for the selection. In the past they have shown heart-shaped cells in microscopic views in early February.
DeleteMy father deeply disliked any kind of flies or insects getting inside his ear; I share that discomforting feeling.
ReplyDelete