A 9-year-old Connecticut boy felt a strange sensation in his right ear, he told his doctor at Yale New Haven Children’s Hospital. Three days earlier, he’d heard a buzzing noise in that ear. Still, the boy felt no real pain, and he could hear perfectly well, according to a case study published Wednesday in the New England Journal of Medicine.
When asked what he’d been doing, the boy said nothing more unusual than playing outdoors at school.
Dr. Erik Waldman, co-author of the report and chief of pediatric otolaryngology at the hospital, peered inside the boy’s ear and saw something unexpected: A tick appeared to be implanted in the right tympanic membrane – the eardrum – where it was surrounded by inflamed tissue.
Waldman attempted to remove the tick, but the embedded arachnid wouldn’t budge. (Ticks are commonly thought to be insects, but they are relatives of spiders.)
Dr. David Kasle, co-author of the report and a resident otolaryngologist at Yale New Haven Hospital, said that “in any kid, removal of a foreign body from an ear is difficult – but especially in this case.” The tick’s capitulum – the mouth parts that do the probing, holding and bloodsucking – was “dug in,” Kasle said. Pulling the tick straight out would cause pain and probably tear the membrane.
“The eardrum essentially acts as a part of a pretty complex lever mechanism to allow sound to travel from the outer ear into the inner ear and through the middle ear, where there are ossicles – small bones,” Kasle explained. “You need that drum intact to get good sound.”
Not removing the tick would also have consequences, he said: Over time, the boy would not be able to hear well. Still, he did not want to “inflict more damage,” including a possible perforation of the eardrum. A hole might not deafen the boy, but it would “dampen” his hearing, Kasle said. Many eardrum perforations heal on their own, he said, but not all.
“We took him to the operating room, put him to sleep, and we were able to use pretty fine utensils to remove the capitulum of the tick,” said Kasle, who performed the delicate operation. The tick was tested and identified as Dermacentor variabilis: a dog tick, commonly found in parts of the United States.
Kasle treated the boy with an antibiotic eardrop to heal any abrasions. One month later, the child was doing well. His tympanic membrane had mended, and he developed neither fever nor rash.
“It’s pretty unusual to have a tick that has embedded itself in the membrane like this,” Kasle said.
The danger of ticks
Dr. Lorenza Beati, curator of the US National Tick Collection and a biology professor at Georgia Southern University, agreed.
Very rarely will ticks attach themselves to unusual places such as inside the ear, Beati, who was not involved in the case study, wrote in an email. “Some ticks in Africa do this, but in the U.S. this is a very very unusual event, particularly because an adult [dog tick] is pretty big and people often discover the tick crawling on them before it attaches.”
In North America, the dog tick is commonly found east of the Rocky Mountains but also in parts of the Pacific Northwest, Canada and Mexico. As the name suggests, ticks of this species can be found on dogs but also on cats and humans. Eight-legged adults sometimes carry and transmit bacteria that cause Rocky Mountain spotted fever, which causes headache, fever and rash, and tularemia, which causes fever and skin ulcers.
“It’s not the first time ticks have been found in unusual places,” said Neeta Pardanani Connally, director of the Tickborne Disease Prevention Laboratory at Western Connecticut State University. Another unlikely tick residence is people’s eyes; Connally, who had no role in the study, has even pulled ticks out of her navel.
Ticks tend to crawl “until they find a warm and cozy spot to attach,” she explained. “It is more common for ticks to be found attached behind knees, in groin areas, in armpits, behind ears. Dog ticks like the one in this article are commonly found attached to human heads.”
The main danger of ticks is their ability to transmit disease. “In the US, the most common tickborne disease is Lyme disease, with an estimated 300,000 cases occurring each year,” she said.
Safety tips from the experts
Beati offered several suggestions to prevent tick bites.
“Wear appropriate clothing when going in the woods (long pants, shirt tucked in the pants, good shoes, no flip-flops!” She added that “a bit of DEET sprayed around your ankles, sleeve cuffs, collar” can also prevent ticks from getting inside your clothes and biting you.
Connally said that bathing or showering within two hours of being outdoors is protective against Lyme disease. Not only does a bath or shower force you to remove what you’re wearing – clothes that may contain a crawling tick or two – but it will wash off any as-yet-unattached ticks.
Beati cautioned, “Do not wait long before removing the ticks. Disinfect after removing if you can.” Use tweezers to gently pull an attached tick from your skin and then scrub the area clean with rubbing alcohol.
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Connally recommended familiarizing yourself with the types of ticks that live near your home and the diseases they carry. If you develop symptoms, including rashes or flu-like illness, in the days or even months after a tick bite, you should see a physician, she said.
And don’t forget the family dog or cat.
“People should also treat their pets with a tick preventative product all year long,” she said.