Tick in the ear.

A 20-year-old woman presented to an outpatient otolaryngology clinic with a 3-day history of an earache on the right. She reported no discharge, tinnitus, or loss of hearing. Otologic examination revealed that a dog tick was adherent to the tympanic membrane (figure). The area where the tick was located was surrounded by an area of hemorrhage.

[FIGURE OMITTED]

The patient was admitted to the ward for removal of the tick under general anesthesia. Intraoperatively, the tick was alive, its abdomen was distended, and its mouthpart was embedded in the tympanic membrane near the umbo. It was completely removed without eardrum perforation. The patient's postoperative course was uneventful.

Ticks are blood-sucking ectoparasites of the class Arachnida. They are classified as hard ticks and soft ticks, depending on the consistency of their covering cuticles. The tick in our patient was a soft tick.

The four stages of the tick life cycle are egg, larva (6 legged), nymph (8 legged), and adult (8 legged). Ticks in all but the egg stage need blood to develop and survive. Their only source of nourishment is animal and human blood. They use their piercing-sucking mouthpart to penetrate the epithelium and suck the host blood. Ticks can transmit several human pathogens.

Removal of a tick that is adherent to the tympanic membrane can be difficult in an outpatient setting. Removal usually requires a short period of general anesthesia.

Omar Rahmat, MS (ORL); Narayanan Prepageran, FRCSEd; Athanari Loganathan, MS (ORL); Rajagopalan Raman, MS (ORL)

From the Department of Otolaryngology, University Malaya Medical Center, Kuala Lumpur, Malaysia.