'Buzz' in the ear.

A 41-year-old woman was referred to the emergency ENT clinic for evaluation of a right earache and buzzing tinnitus. These symptoms had arisen 2 days following the accidental spill of a liquid into her ear from a small bottle while she had been engaged in sexual relations. She brought the 10-ml bottle that had contained the liquid; the trade name was "Buzz." The bottle contained an alkyl nitrite, a sphincter relaxant that is sometimes used as an aphrodisiac. The concentration was not specified on the label. The patient was otherwise fit and well, and she had had no previous ear problems.

Otoscopy revealed an inflamed right tympanic membrane with an inflamed and erythematous bulla on the lower half; there was no perforation (figure). This appearance was similar to that of acute bullous myringitis. (1) Findings on audiometry were within normal limits, but tympanography showed a reduction in mobility on the right side. The patient was treated with an analgesic, a steroid, and neomycin eardrops to reduce the inflammation and irritation. She made an uneventful recovery.

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As an aphrodisiac, alkyl nitrites are particularly popular among the homosexual community. (2-4) They are a volatile and unstable group of compounds that hydrolyse into the alcohol and nitrite ion. (2) Dunkel et al reported in 1989 that alkyl nitrites have been demonstrated to be mutagenic in bacteria and that male homosexuals with Kaposi's sarcoma were also heavy users of nitrites. (3) No dermatologic reactions or ear problems from these compounds have been previously described in the literature.

References

(1.) Jahn AF. Infections and inflammations of the external ear canal. In: Ludman H, Wright T, eds. Diseases of the Ear. London: Arnold Publications, 1998:317.

(2.) Tytgat J, Daenens P. Solvent-free sample preparation by headspace solid-phase microextraction applied to the tracing of n-butyl nitrite abuse. Int J Legal Med 1996;109:150-4.

(3.) Dunkel VC, Rogers-Back AM, Lawlor TE, et al. Mutagenicity of some alkyl nitrites used as recreational drugs. Environ Mol Mutagen 1989;14:115-22.

(4.) Poulsen PA. [Alkyl nitrite as an aphrodisiac]. Ugeskr Laeger 1983;145:2213-15.

From the Department of Otorhinolaryngology-Head and Neck Surgery, Leeds General Infirmary, Leeds, U.K.