Unusual foreign body in the middle ear – a case report

Introduction:

Ear injuries due to foreign bodies usually affect the external auditory canal and the tympanic membrane. The involvement of the middle ear structures is rare. However, close anatomical relationship of the internal carotid artery and the jugular vein to the inner and middle ear structures might pose a diagnostic challenge, especially when the vessel laceration cannot be ruled out.

Case:

A 55-year-old woman was admitted to the emergency unit of the University hospital with a pair of scissors, which she inserted into her right external auditory canal in a suicidal attempt. At admission, the patient was fully conscious and did not present any otolologic symptoms. She showed regular facial nerve function and no nystagmus. In the CT scan, the scissors perforated the tympanic membrane. It's tip passed the ossicular chain and the facial nerve and projected exactly to the triangle between the cochlea, the internal carotid artery, the bulb of the jugular vein. Because of the metallic artefacts in the CT scan (with contrast), the laceration of the intracranial vessels could not be completely excluded. To enable therapeutic embolisation in case of intracranial bleeding, the removal of the scissors was performed during the angiography in general anaesthesia, followed by tympanoplasty and exploration of the middle ear.

Conclusion:

The proximity of vessels in the petrous bone complicates the diagnostic and therapeutic procedures for metallic foreign bodies in the middle ear. Such a case requires close cooperation of anaestesia, radiologic and ENT- departments. We recommend use of interventional angiography, if intracranial vascular injury cannot be reliably ruled out on CT scan.

Publication History

Publication Date:
23 May 2018 (online)