|Year : 2014 | Volume
| Issue : 1 | Page : 37-38
Round worm in the ear: A clinical rarity
Vidya Bhushan Rangappa, Shantanu Tandon
Department of ENT, Head and Neck Surgery, St. Johns Medical College Hospital, Bengaluru, Karnataka, India
|Date of Web Publication||1-Apr-2014|
Vidya Bhushan Rangappa
Department of ENT, Head and Neck Surgery, St. Johns Medical College Hospital, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Foreign body in otolaryngology practice is a common scenario. There have been very few documentations of a worm entering the ear through the Eustachian tube. We hereby report a very interesting such case and also discuss the possible cause postulated for such events.
Keywords: Ascaris, Foreign body, Otorrhea, Round worm
|How to cite this article:|
Rangappa VB, Tandon S. Round worm in the ear: A clinical rarity. Indian J Otol 2014;20:37-8
| Introduction|| |
A large variety of foreign bodies may be encountered in the external auditory meatus. The objects may be organic or inorganic. The most common complications of a foreign body in the ear are bleeding and otitis externa. 
| Case Report|| |
A 4-year-old child was brought to the Pediatric Emergency department with a history of fever and muscle spasms since 1 week. He was in altered sensorium since 1 day. He also had bilateral otorrhea since 6 months of age. Otorrhea was copious, foul smelling, non-blood stained. Ear discharge was increasing on entry of water in to the ear and during upper respiratory tract infection. Ear discharge subsided with topical and systemic antibiotics. On examination, there was ear discharge filling both the external auditory canals which foul smelling and non-blood stained. Pus was taken for culture and sensitivity. Dry mopping of both the ears was done. Right tympanic membrane showed a small central perforation. There was a central perforation involving anteroinferior and anterosuperior quadrant on left side. Middle ear mucosa was congested. Since he developed respiratory distress, he was intubated. With a provisional diagnosis of tetanus, he was admitted in intensive care unit by the pediatrician and managed accordingly. On day 2 of admission, during routine ear examination, we found a worm in the left external auditory canal. The worm was partly in the middle ear cavity and partly in the external auditory canal. The worm was cream colored. The worm was gently held using aural forceps and pulled out of the ear [Figure 1]. It was sent to the microbiology lab for identification. The worm was identified as Ascaris lumbricoides. It was measuring 13 cm in length. The worm was seen wriggling in the container [Figure 2].
| Discussion|| |
Foreign bodies in the external ear are most frequent in otolaryngological practice.  Numerous foreign bodies have been reported so far in the ear of the children. Roundworm crawling out of the middle ear cavity is rare and fascinating.
Ascariasis is common in India and it is well-known for its numerous infrequent complications. Ascariasis in the middle ear is very rare though complications such as mastoiditis, facial paralysis, suppurative labyrinthitis and intracranial suppuration have also been reported. 
Migration of the adult worm up the Eustachian tube More Details into the middle ear is very rare but it has been documented. , The anatomic explanation for its presence in the middle ear cavity is, when either during vomiting, or ascending of A. lumbricoides in to the oral cavity or nasopharynx, the worm enters Eustachian tube.  In children, the Eustachian tube is shorter, wider and horizontal so it may be possible for a migrating worm to enter it.  Our child had no episode of vomiting after hospitalization.
Fornazierie et al., in review of 462 cases of foreign bodies in ear found 40.5% patients were above 16 years of age and 50.27% foreign bodies were insects. 
There is a possibility of the worm blocking the Eustachian tube and there by leading to the recurrent episodes of ear discharge. The worm had made its way out of the middle ear cavity through the perforation.
| References|| |
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[Figure 1], [Figure 2]