Citation

Schreier A, Sharaf K, Müller J. Dtsch. Arztebl. Int. 2023; 120(21): e376.

Copyright

(Copyright © 2023, Deutscher Ärzte-Verlag)

DOI

10.3238/arztebl.m2023.0002

PMID

37530055

Abstract

A 35-year-old male presented within 15 months of a perforating cotton swab injury to the right ear. Dislocation of the incus had initially been suspected at another center due to tympanic membrane perforation and hearing loss. Otomicroscopy showed an intact tympanic membrane, while pure tone audiometry revealed mixed middle- and inner-ear hearing loss. The recommended surgical opening of the middle ear cavity needed to be postponed due to COVID-19 regulations. Surprisingly, deafness was present preoperatively. When asked, the patient reported progressive hearing loss and attacks of rotatory vertigo, for which no medical advice had been sought. Intraoperatively, fracture of the stapes footplate was seen. Reconstruction was performed, without achieving an improvement in hearing, as expected; however, no further attacks of rotatory vertigo were reported. The patient was offered cochlear implant treatment. Cotton swabs are frequently used despite advice to the contrary; they represent the most common cause of foreign body injuries in traumatic tympanic membrane perforations. These are usually simple tympanic membrane injuries that, when splinted, heal without loss of function. Complications are rare but require prompt action. Hearing loss and vertigo are indicative of a perilymphatic fistula, for example due to a fracture of the stapes. Since further losses of function can occur subacutely, timely surgical exploration is indicated in the case of complications.

Language: en

Keywords

Humans; *Deafness; *Specimen Handling