AN UNEXPECTED GUEST: HUMAN OTOACARIASIS IN A CHILD WITHOUT ANIMAL CONTACT

Abstract

Background: Human otoacariasis is an uncommon but clinically important form of animate foreign body infestation of the external auditory canal. It is usually associated with exposure to animals, vegetation, or rural environments. This report describes an unusual pediatric case in which no direct animal contact was identified.

Case presentation: A 12-year-old girl presented with a 2-day history of left-sided otalgia, aural pruritus, and a persistent crawling sensation. Video-otoscopy revealed a live dark-brown hard tick attached to the posterior wall of the external auditory canal with localized erythema, edema, and granular debris on the canal floor and tympanic membrane. The child had no previous otologic disease, no pet ownership, and no recalled contact with domestic or wild animals.

Outcome: A 2% lidocaine solution was instilled for chemical immobilization. The tick was then removed intact under video-endoscopic guidance with micro-alligator forceps, followed by gentle microsuction, local antiseptic irrigation, and topical corticosteroid-antibiotic therapy. The attachment site showed a focal hyperemic feeding lesion, but the tympanic membrane remained intact. At 48-hour review, pain and pruritus had resolved, edema had subsided, and no neurological or systemic sequelae were observed.

Conclusion: This case shows that pediatric otoacariasis can occur even without direct animal contact. Indirect environmental exposure through household or peridomestic substrates should be considered. Safe management depends on early visualization, chemical immobilization before extraction, complete removal, local wound care, and short-term follow-up. The case supports a broader exposure history and a cautious extraction sequence for children with animate aural foreign bodies.