番茄社区

A man with a compulsive interest in cleaning his ears with Q-tips ended up in the hospital with a brain abscess caused by a cotton swab that got lost in his ear canal, a researcher reported.

"Brain abscess usually occurs as a result of predisposing factors such as HIV or other immunosuppressive state, systemic infection, or disruption in the protective barrier surrounding the brain, including trauma, operative procedures, mastoiditis, sinusitis, or dental procedure," said Benjamin Carmel, MD, of Aventura Hospital and Medical Center in Florida.

But none of those conditions were responsible in the case he reported at , the American College of Chest Physicians annual meeting held online.

"We report a very unique case of subdural empyema and abscess with associated mastoiditis and sinus thrombosis in the setting of a retained cotton swab," Carmel said. He described what happened when the 47-year-old man, who had a past medical history of hypertension, presented with stroke-like symptoms -- left arm weakness and numbness and left-sided facial droop.

Imaging with CT detected a mass in the posterior right parietal lobe. MRI showed a subdural empyema and extra-axial mass, thrombosis of the right transverse and sigmoid sinuses, right mastoiditis≤ and medial erosion of air cells. A chronic left occipital abscess was also visualized on MRI with contrast.

The patient was treated with antibiotics and managed in the intensive care unit in case of septic shock, and taken for right craniectomy with empyema evacuation and tympanomastoidectomy.

During the surgical procedure, a posterior canal incision was made to the mastoid cortex and a cotton swab was found and retracted. The swab was attached to granulation tissue coming through the ear drum. Pathology confirmed cotton material representing a cotton swab, gram stain showed gram-positive cocci in pairs, and surgical culture grew Anaerococcus species.

Carmel said it appears that this infection with Anaerococcus species was unique in the medical literature, and noted that the patient had not been sure how long the swab had been in his ear, but that the referring otolaryngologist said that based on the amount of granulation tissue, it was likely the swab had been there a long time.

"The patient did note that he was very obsessive about cleaning his ear with Q-tips and he did so very frequently," Carmel said, adding that it wasn't clear if the patient had subsequently stopped.

"Warnings against using cottons swabs in the ear canal exist due to the risk of a foreign body worsening cerumen impaction, and tympanic membrane rupture," Carmel said.

While the extent of the damage seen in the case is unusual, injuries due to use of cotton swabs are not infrequent, said Robert Glatter, MD, an emergency physician at Lenox Hill Hospital in New York City, who was not involved with this patient's case.

"It's quite common for adults and teens to seek treatment in the emergency department for foreign bodies that get lodged in their ears," he told 番茄社区. "The most common example is someone, who while cleaning their ears, has a cotton swab that breaks off inside the ear canal, and then often works their way deeper into the ear canal, with the swab becoming lodged against the ear drum."

Removal of the object in the emergency department is relatively straightforward, Glatter said.

"The number one piece of advice I always give my patients is to never use Q-tips to remove ear wax," he said. "The safest way to accomplish this is to use over-the-counter ear wax removal drops/kits along with some gentle irrigation or bulb-type suction. This facilitates removal in a safe and controlled manner.

"While irrigation using a solution of warm hydrogen peroxide and saline for difficult-to-remove wax is a valid approach by healthcare professionals, more careful removal using suction and manual removal by a specialist is advisable for long-term wax or dried wax that is difficult to remove," Glatter continued.

Also, he emphasized, the foreign object should be removed as soon as possible. "The longer the cotton tip remains in the ear canal or against the eardrum, the greater the risk of infection as well as the difficulty removing it," he said. "If the tympanic membrane is perforated, complications such as abscess and mastoiditis become more likely."

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