The 31-year-old presented to the emergency room suffering from seizures. Doctors discovered in his ear canal a piece of cotton swab that had been forgotten for 5 years, responsible for a serious infection that had spread to the lining of his brain.
Perforation of the eardrum, irritation, wax plug… The cotton swab may be found in most bathrooms, but its use remains controversial. Not only accused of polluting the oceans, it is also the cause of many hospital visits.
Like that of this 31-year-old Englishman, whose medical case was reported by the very serious BMJ Case Reports. Complaining of pain for about ten days in the left ear, the patient was admitted to Conventry hospital for convulsions and otorrhoea: a purulent liquid flowed from his external auditory canal. He also complained of severe headaches and had cognitive impairment, such as difficulty remembering people’s names.
A life-threatening infection
These problems were not new: the man explained to the doctors that he suffered regularly from pain in his left ear and had noticed hearing loss for the past five years. He was also treated twice for a serious infection in his left ear.
Fearing a new infection, the medical team gave him a CT scan. The images revealed two abscesses, i.e. two inflamed areas filled with pus in the bones at the base of his skull, near the left ear canal. The man actually suffered from necrotizing otitis externa: a life-threatening infection of the soft tissues of the external auditory canal, which runs from the outside of the ear to the eardrum.
Spread to the meninges
But how could the bacterial infection spread through the ear canal to the brain wall? Ear specialist Dr Alexander Charlton at University Hospital Coventry operated on the patient and located a piece of cotton swab at the bottom. The latter was covered in earwax, suggesting it had been there for several years, Dr Charlton said.
It is this piece of cotton swab that is the source of the bacterial infection. This started in the ear canal, progressed through the bone at the base of the skull and then moved into the wall of the brain, the meninges, details Dr. Charlton.
Fortunately, the infection did not progress beyond the mucosa and therefore did not reach the brain. It was she who, however, caused all the neurological symptoms from which the patient suffered.
Be careful when using cotton swabs
According to the website LiveScience, the man spent a week in hospital and had two months of oral and intravenous antibiotic treatment to cure the infection. He subsequently had no further hearing or neurological problems.
However, the medical team advised him never to use a cotton swab to clean his ears again. “They can only cause problems,” says Dr. Charlton.
Indeed, the cotton swab should be used sparingly and with caution. Used too harshly, it can injure the skin or the eardrum – even if it means breaking it. Regular irritation is also a risk factor for eczema. Furthermore, the tool tends to push the earwax to the bottom of the duct, which promotes the formation of plugs.
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