Otoplast in the middle ear cleft — a rare complication of hearing aid fitting and its surgical management

Abstract

Hearing aid fi tment is a routine, usually safe procedure carried out by hearing aid technicians or even audiologists. Hearing aids are often considered the benign, non-surgical alternative to rehabilitate a patient who cannot be helped surgically. It is rare to have to resort surgery to manage a complication resulting from hearing aid fi tting. We report here, a case of otoplast as a foreign body in the middle ear cleft (middle ear cavity and mastoid). The otoplast was used to prepare a mould for the hearing aid and the syringe carrying the otoplast burst splashing the material into the middle ear and the mastoid. This resulted in sudden excruciating pain, further loss of hearing and intractable otorrhea. After several attempts to remove the material elsewhere, our patient underwent a successful mastoid exploration to remove the otoplast resulting in a dry ear after seven years of persistent otorrhea. Patient's professional requirement for good hearing necessitated a myringoplasty on the other (only hearing) ear. He is now happily rehabilitated with a dry but deaf left ear and a normally hearing right ear.

Complications of ear mold impressions: two case reports

“…In the cases of asymptomatic patients, if the hearing aid dispenser is unaware that the hearing aid impression mold material is retained, the onset of symptoms may take several years. At that time, the symptoms are often similar to the ones of chronic otitis media, such as intractable otorrhea and formation of granulation tissue as reported by Lee et al and Dhawan et al [1,2].…”

“…Even though there are some case reports and short series descriptions such complications are rarely reported but are likely to be more frequent [1][2][3]5].…”

“…Mold impressions taken by untrained hands can cause serious trauma leading to further hearing impairment and disability [2,3,5]. Other than a careful history taking, it is important to perform an adequate assessment of a clean external ear canal in order to have a complete visualization of the tympanic membrane [4,6].…”

“…Complications are rare but can occur, namely the entrance of impression material in the middle ear in case of iatrogenic perforation or in a preexistent perforation [1][2][3][4].…”

Impression Material in the External and Middle Ear: an Overview of the Literature and a Stepwise Approach for Removal

“…Extra caution should be taken in the presence of risk factors such as tympanostomy tubes, tympanic membrane perforations, and retraction pockets, and when the patient has a history of previous surgery, such as mastoidectomy [1] . The first case report was published in 1983 [6] , and a literature search revealed 40 similar cases published in English, varying only in external or also middle ear involvement [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . Table 1 provides an overview of those 34 cases in the literature with middle ear involvement and for whom the respective (surgical) removal procedures were described.…”