Human otoacariasis

Unusual Presentation of Otoacariasis: A Prospective Study at Referral Teaching Hospital

Otoacariasis is the presence of ticks and mites within the ear canal. Though the coexistence of ticks and humans is known for thousands of years, tick infestation is relatively rare in urban population. The most common presenting symptoms are usually itching, otalgia and a foreign body sensation and less frequent ones are tinnitus and otorrhoea. We report cases of otoacariasis with unusual presentation. A total of 43 cases presented to the ENT clinic in our hospital over a period of three years from 2018 to 2021. We present patients who presented with unusual symptoms of conductive hearing loss, ear bleed, and facial palsy. Total of 6 cases of otoacariasis had unusual presentation. 2 cases presented with lower motor neuron palsy, 1 case with ear bleed, and 3 cases with hearing loss. Otocariasis can present with unusual symptoms of hearing loss, ear bleed or facial palsy and this should be included in the differential diagnosis of a patient with history of close proximity to domestic or wild animals. Detailed examination often reveals the presence of the tick and identification and complete removal along with appropriate medication for associated symptoms often results in complete recovery.

A checklist of the ticks of Malaysia (Acari: Argasidae, Ixodidae), with lists of known associated hosts, geographical distribution, type localities, human infestations and pathogens

Studies of ticks in Malaysia from past articles were reviewed, resulting in a list of 47 species belonging to seven genera (Argas, Ornithodoros, Amblyomma, Dermacentor, Haemaphysalis, Ixodes, and Rhipicephalus). The most prevalent genus in Malaysia is Haemaphysalis (20 species), followed by Amblyomma (eight species) and Dermacentor (seven species). Out of 47 species, only 28 have bitten humans, mostly belonging to Haemaphysalis. The most researched tick-borne pathogens in Malaysia are Rickettsia and Anaplasma, and most research was focused on the tropical-lineage brown dog ticks, R. sanguineus sensu lato, and the cattle ticks, Haemaphysalis bispinosa and Rhipicephalus microplus. 18 species were excluded from the list due to lack of definite records or dubious findings: Ornithodoros mimon, O. turicata, Amblyomma breviscutatum, A. clypeolatum, A. integrum, A. maculatum, Dermacentor marginatum, D. taiwanensis, Haemaphysalis birmaniae, H. flava, H. humerosa, H. longicornis, H. punctata, H. sulcata, Ixodes holocyclus, Rhipicephalus appendiculatus, R. annulatus and R. bursa. This paper presents the first complete and updated list for Dermacentor and Ixodes tick species in Malaysia since Kohls (1957).  

Management of Live Insects in the External Auditory Canal: A Wilderness Perspective

A live insect within the external auditory canal is an unpleasant possibility during wilderness recreation. To our knowledge, no study has attempted to quantify the risk of this event occurring in the wilderness. However, such events anecdotally seem to occur with some regularity in a variety of climates. Most cases are benign, but a small subset of patients can develop complications including infection, hearing loss, and vestibular complaints related to the foreign body. In the emergency department or clinic, removal of the insect is a simple procedure in most circumstances; however, the material and expertise required for backcountry removal of the insect are often limited. With this consideration in mind, we offer a conservative approach to backcountry insect removal based on a selective review of the published literature on this topic. Where published data are lacking, we make recommendations based on anecdotal experience of the authors dealing with this condition in austere environments and in the emergency department. We recommend insect removal only if the patient is acutely symptomatic and the insect is visualized and graspable with the instrument used for removal. In any other circumstance, intervention should be deferred until definitive care is reached because of risks of complications associated with removal, including infection, bleeding, and tympanic membrane damage.

Human Otoacariasis in Two Climatically Diverse Districts in Sri Lanka: Seasonality, Risk Factors, and Case Notes

PURPOSE

Otoacariasis is a parasitic otopathy reported in many parts of the world. This study presents the seasonal pattern, risk factors, and case notes on human otoacariasis in two climatically different districts: Anuradhapura and Kandy in the Dry and Wet/Intermediate zone of Sri Lanka, respectively.

METHODS

Ticks removed from the ear canal of patients were collected. Risk factors of otoacarisis were determined by a case/control follow-up study.

RESULTS

Nymphal Dermacentor auratus (90.8%) was the main tick species associated otoacariasis. In the Kandy District, infestation was year-round, while in the Anuradhapura District, it was seasonal with a peak in December-February. Children < 10 years were a risk group in both districts. Females were a risk group in the Kandy District. Engagement in outdoor activities was a risk factor in both districts. In addition, the presence of wildlife and domesticated animals were risk factors in the Kandy and Anuradhapura districts, respectively. The treatment protocols in the two hospitals were different. An infant with otoacariasis from the Anuradhapura District developed rickettsia.

CONCLUSIONS

Although the tick species was the same, seasonality, risk groups, and risk factors in the two districts were different which could be due to the establishment and persistence of tick populations influenced by biotic and abiotic factors.

Morphological and molecular identification of medically important questing Dermacentor species collected from some recreational areas of Peninsular Malaysia

Questing is a situation when a tick is seeking to get closer or ambush its potential host. However, information on questing tick species in Malaysia is still lacking, thus the association with tick-borne diseases (TBD) is not completely understood. The aim of this study was to investigate the tick species from five most frequently visited recreational areas in Pahang and Terengganu states, which were recorded to have high potential of TBD cases. By implementing handpick method, a total of 18 males and 15 females belonging to five Dermacentor Koch, 1844 species, were collected, namely D. compactus Neumann 1901, D. tricuspis (Schulze, 1933), D. auratus Supino 1897, D. steini (Schulze, 1933), and D. falsosteini Apanaskevich, Apanaskevich & Nooma respectively. The specimens were collected and identified based on morphological characters prior to obtaining the molecular data of COI and 16S rDNA. The D. compactus was the most abundant species collected in this study, while D. falsosteini was the least. All species were distinctly separated on the Neighbor Joining and Maximum Parsimony tree topologies and supported with high bootstrap values. Furthermore, a low intraspecific variation (0.00 - 0.01) was observed amongst the individuals of the same species in both genes. Meanwhile, each Dermacentor species was genetically different, with interspecific values ranging from 0.13-0.19 and 0.11-0.20 for COI and 16S rDNA. These findings had successfully recorded the tick species that were potentially associated with TBD, and which might be circulated among humans and animals. This study also has some implications on the diversity and geographical extension of Dermacentor ticks, thus should warrant further investigation as a potential vector of tick-borne diseases and public health importance.

Ticks and tick-borne pathogens in animals and humans in the island nations of Southeast Asia: A review

Ticks are blood-feeding ectoparasites and major vectors of pathogens that cause infectious diseases in humans and animals worldwide including mammals, birds and reptiles. Despite the growing scientific effort in the 20th century, there is still limited information on ticks and tick-borne pathogens in Southeast Asia, especially concerning medical, veterinary, socioeconomic and agricultural aspects in the island nations. This review provides an overview of the current state of knowledge of ticks and their pathogens in the island nations of Southeast Asia and peninsular Malaysia. We aim to stimulate further research studies on ticks and tick-borne pathogens of human and veterinary importance in this geographical region.

Foreign Bodies of the Ear, Nose and Throat

Foreign bodies to the ear, nose, and throat often can be managed in the emergency department, particularly if the patient offers a history consistent with foreign body and is calm and compliant with the examination and removal attempts. Tips for success include analgesia, adequate visualization, immobilization of the patient's head, dexterity and experience level of the provider, and minimizing attempts at removal. It is critical to recognize the risks involved with certain retained objects (button batteries or sharp objects) and when to call a consultant to help facilitate safe, successful removal of objects to the ear, nose, and throat.

Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone

A number of infectious, inflammatory and idiopathic lesions develop within otologic tissues that may share similar clinical and/or microscopic features. This review first provides a working classification for otitis externa, and then otitis media and includes two recently described entities, eosinophilic otitis media and otitis media with ANCA-associated vasculitis. Next, the microscopic findings of a spectrum of otopathologic conditions are described, including post-inflammatory conditions such as tympanosclerosis and aural polyps, an overview of animate aural foreign body as well as iatrogenic aural foreign body reactions. Finally, a review of fungal disease affecting the ear with a brief synopsis of Candida auris, a recently described and virulent organism, is presented.

Ticks in the External Auditory Canal

Ticks attack a wide range of vertebrates including humans, and are important vectors of numerous pathogens, e.g. virus, rickettsia, and protozoa. We present a case of ticks found in the external auditory canal. A 12-year-old girl presented to the emergency service with one-day history of right-sided earache. Otological examination found a tick blocking the external auditory canal. The tick was removed under local anaesthesia with a light microscope. After the tick was removed, another tick was detected in the external auditory canal. The second tick was not adhered to the ear canal skin and was mobile. It was also removed completely. The patient's post-procedure course was uneventful. A broad spectrum antibiotic, an analgesic, and an antihistamine were prescribed. Both ticks were sent to the infectious disease laboratory for investigation of Crimean-Congo haemorrhagic fever. They turned out to be Hyalomma species.

Insecticidal activity of common reagents for insect foreign bodies of the ear

OBJECTIVE

Insects commonly present as painful and distressing foreign bodies of the external ear canal. Removing live insects can be challenging, especially for primary care physicians who have limited equipment. The purpose of this study is to compare the insecticidal activity of commonly available preparations for insects that are most frequently recovered from ear canals: cockroaches (German and American), ticks, beetles, and honeybees.

STUDY DESIGN

Prospective, blinded.

METHODS

One hundred seventy insects of each species were placed in test tubes and submerged in 17 test preparations (10 tubes per preparation, 1 insect per test tube). Insect activity was stimulated by agitation of the test tube. Responses were monitored, and the time until death was measured.

RESULTS

Most test preparations exhibited some insecticidal activity against most insect species. Ticks were completely resistant to all of the test reagents. Ethanol killed the American cockroaches (mean time, 32.6 s), German cockroaches (mean time, 29.6 s), and honeybees (mean time, 19.6 s) the most rapidly.

CONCLUSION

Many commonly available reagents may be used to kill or immobilize insect foreign bodies of the ear.