Abstract
We report an extremely rare case of hearing aid silicone impression material as a foreign body in the middle ear. Symptoms of the patient were otorrhea and vertigo after taking of a mold impression on his only hearing ear, and the symptoms mimicked chronic otitis media. A temporal bone CT scan revealed foreign body material in the middle ear and Eustachian tube. An intact canal wall mastoidectomy with a facial recess approach and type IV tympanoplasty was performed to remove the silicone impression material. In addition to the case report, we review the literature regarding impression material foreign bodies.
1
Introduction
Fitting a hearing aid usually requires the making of an ear canal mold, which contributes to the quality of hearing aid. This procedure usually has no complications. However, a few cases of a silicone impression material foreign body during ear mold taking have been reported . We experienced a case of hearing aid silicone impression material as a foreign body in the middle ear. We report this case herein, together with a discussion of similar cases in the literature.
2
Case reports
A 62-year-old male with long standing left-side deafness visited a secondary referral hospital because of right-side hearing disturbance for 1 year. He had diabetes and underwent tympanoplasty on his left ear 6 years prior. A hearing aid for his right ear was prescribed and silicone impression material for hearing aid was introduced into his right ear canal at a local hearing aid shop. A few weeks later, he felt vertigo and otorrhea in his right ear. After antibiotic treatment at a local hospital, symptoms were not improved. The patient was referred to a tertiary referral hospital with suspicion of labyrinthitis 6 months after the trauma. Erythema of the canal wall and crust with active otorrhea were observed in his right-ear canal ( Fig. 1 ). Mixed hearing loss was checked on pure tone audiometry (PTA) on his right side, as there was no residual hearing on his left side ( Fig. 2 ). A high-resolution temporal bone computed tomography (CT) scan was performed, and imaging revealed soft tissue density and high-density materials in the right middle ear cavity and Eustachian tube ( Fig. 3 ).
One month later, a right intact canal wall mastoidectomy with a facial recess approach and type IV tympanoplasty was performed to remove the foreign material. Before the surgery, swelling of the right ear canal was worsening. The lower-tone hearing level of the right ear was poorer than that 1 month ago. Right ear was the only hearing ear of the patient, and so informed consent regarding the possibility of hearing loss was obtained before the surgery. A retroauricular incision was made for mastoidectomy. Green foreign material was seen through the ear canal after removing granulation tissue. The foreign material was not fixed in the middle ear cavity, and an incision was made in the material. The material was then removed relatively easily through the ear canal. The shape of the foreign material was the same as the middle ear cavity and it reached the Eustachian tube ( Fig. 4 ). There was severe inflammation and granulation tissue in the middle ear, and the malleus, incus and suprastructure of the stapes were damaged. After removing all granulation tissue, a 3 mm titanium total ossicular replacement prosthesis was placed for type IV tympanoplasty. Pseudomonas aeruginosa was cultured from the discharge of the middle ear. The surgery was performed without any other complications. The post-operative course was uneventful and the symptoms of otorrhea and vertigo were relieved.
2
Case reports
A 62-year-old male with long standing left-side deafness visited a secondary referral hospital because of right-side hearing disturbance for 1 year. He had diabetes and underwent tympanoplasty on his left ear 6 years prior. A hearing aid for his right ear was prescribed and silicone impression material for hearing aid was introduced into his right ear canal at a local hearing aid shop. A few weeks later, he felt vertigo and otorrhea in his right ear. After antibiotic treatment at a local hospital, symptoms were not improved. The patient was referred to a tertiary referral hospital with suspicion of labyrinthitis 6 months after the trauma. Erythema of the canal wall and crust with active otorrhea were observed in his right-ear canal ( Fig. 1 ). Mixed hearing loss was checked on pure tone audiometry (PTA) on his right side, as there was no residual hearing on his left side ( Fig. 2 ). A high-resolution temporal bone computed tomography (CT) scan was performed, and imaging revealed soft tissue density and high-density materials in the right middle ear cavity and Eustachian tube ( Fig. 3 ).
