Curious case in Graz

Living ant in the middle ear: woman had tinnitus

The live ant (marked in white) had crawled into the patient's middle ear through a hole in the eardrum.

(Bild: Diagnostics/Peter Kiss et al., Krone KREATIV)

ENT specialists in Graz have now described a highly unusual and hitherto unique case. A sudden onset of tinnitus and a foreign body sensation in the ear of a 42-year-old woman was caused by a live ant that had crawled into the patient's middle ear through a hole in her eardrum.

"This report describes the unusual case of a live ant that entered the middle ear cavity through a pre-existing perforation in the eardrum of a 42-year-old female patient. She presented at the outpatient clinic with symptoms such as sudden onset of tinnitus (ringing in the ears) and a foreign body sensation in her left ear," write Peter Kiss from MedUni Graz's Department of ENT and his co-authors in the journal "Diagnostics"

The matter turned out to be quite complicated. An examination using an ear microscope initially revealed an oval hole in the eardrum of the left ear. Behind it, however, the ENT specialists saw a "dark foreign body" that was also moving. The authors of the case report: "The object was identified as a living ant." The insect had apparently crawled through the external auditory canal and the perforation into the middle ear.

Insect was removed by surgery
"Initial attempts to remove the insect under local anesthetic were unsuccessful, so the patient had to undergo surgery," the doctors explained. An endoscopic procedure was performed under general anaesthetic "and the ant was removed successfully and without complications." The patient was able to leave the hospital the next day. The recovery went without complications. The hearing problems were eliminated with the removal of the insect.

"This case highlights the rare but possible occurrence of live foreign bodies entering the middle ear through eardrum perforations and the need for timely surgical intervention to prevent complications," the experts concluded. Foreign bodies in the external auditory canal are relatively common, but rare in the middle ear.

Graz case quite unique
The ENT specialists also looked at the international scientific literature. There they found cases of fly larvae that had entered the middle ear of those affected. Foreign bodies in the external auditory canal are insects in ten to 50 percent of cases, according to the international figures.

"Unique clinical scenario"
However, the incident in Graz is quite unique. "Our particular case of a live ant that entered the middle ear through an existing eardrum perforation represents a unique clinical scenario," said the doctors.