A man whose ear had itched for two months turned out to have mites crawling in his ear canal, a new case report says.

The 70-year-old man in Taiwan also reported feeling a sense of fullness in the right ear, but had no hearing impairment, ringing in his ears or discharge. Upon looking into the man's ear canal, doctors discovered mites and mite eggs, belonging to a species identified as the house-dust mite Dermatophagoides pteronyssinus, according to a report of the man's case published Thursday (Oct. 4) in the New England Journal of Medicine.

Having mites in one's ear, a condition formally called otoacariasis, is pretty rare, said Dr. Ian Storper, director of otology at the New York Head & Neck Institute at Lenox Hill Hospital in New York. The video the Taiwan doctors captured of the mites crawling in the man's ear shows the typical swelling of the ear tissue, and debris in the ear canal that is found in such infections, he said.

"It's much more common to see a cockroach in the ear," Storper said, estimating that he's seen a few dozen cases of cockroaches, but only two cases involving mites. Most of the time, the cockroach is dead inside the ear canal when the patient comes in — the difficulty that insects have in walking backward may account for their inability to get out. If it's alive, the patient is likely to report hearing a buzzing sound, along with their pain, he said.

Dr. Richard Nelson, vice chair of emergency medicine at Ohio State University Wexner Medical Center, said that he's learned — after seeing cases of mosquitos, gnats, and at least a dozen cockroaches in ears over his three decades in medicine — that sometimes it's better to tell the patient about the bug after it has been extracted.

In the first cockroach-in-the-ear case he saw as a medical resident, the female patient became so agitated that he thought he might have to sedate her in order to remove the insect.

"She was really freaked out," Nelson said, and he's had other patients who, upon being told about the creature lurking in their ear canals, start screaming or running around — which makes them very hard to treat.

"Now, I just say, I think I see the problem, I'm going to put some stuff in your ear," and tell them about it after the cockroach is out, he said. Some patients are surprisingly calm upon hearing the news, and one patient even told him he'd had a cockroach in his ear before, he said.

Nelson also said he now sometimes knows, before he looks in the ear, what he's likely to see. "Patients with cockroaches in their ear always show up at 2 a.m. — they wake up with sudden onset of ear pain," because the bug crawled in while they were sleeping, he said.

Typically, treatment involves irrigating the ear canal — oil, alcohol, or an anesthetic might be used. The irrigation may flush out the bug, or tiny forceps might be used to pull out the critter.

"It's very important to pull out the whole thing," Storper said. Sometimes, he said, a bug's legs may get stuck or fall apart, leaving leggy bits behind. "If you leave legs, you can get a bacterial infection. They're dirty, they've been crawling everywhere," he said.

In the Taiwan case, the doctors reported treating the patient with eardrops containing an antifungal agent, an antibacterial agent, an anti-inflammatory medicine and an anti-mite medication. The typical treatment for mites in the ear is an anti-mite drug, Storper said, and the other drugs likely helped reduce the risk of other infections.

Two months after treating the Taiwan man, the doctors followed up with him and reported that his symptoms had completely resolved. In most cases, pain and other symptoms go away within a few days of treatment, Storper said.

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