Tick Attached to the Tympanic Membrane

A 9 year old boy presented to the pediatric otolaryngology clinic with a sensation of the presence of a foreign body in his right ear. He also reported that he had heard buzzing noises in his right ear 3 days earlier. He lived in Connecticut and had been playing outdoors at school. He had no pain, tinnitus, or loss of hearing. On physical examination, a tick was seen on the right tympanic membrane, with surrounding inflammation. Removal of the tick with guidance from an operative microscope was attempted in the office, but the tick could not be removed.

Please note that this image might contain sensitive content. Click to unblur.

The patient was subsequently transferred to the operating room for removal of the tick while he was under general anesthesia. The tick was again seen attached to the tympanic membrane; the tick’s capitulum was buried beneath the epidermal layer of the tympanic membrane. The underlying fibrous layer of the membrane remained intact. The tick was removed with a day hook, with guidance from an operative microscope. Subsequent pathological testing identified the tick as Dermacentor variabilis. After extraction of the tick, the patient had no signs or symptoms suggestive of systemic illness, and he was treated with ciprofloxacin eardrops for an abrasion of the tympanic membrane. One month later, the patient was doing well; he had no fever or rashes, and the tympanic membrane had healed well.