A 64-year-old woman presented to the otolaryngology clinic at a Taiwanese hospital because she’d been hearing abnormal sounds in her left ear for 4 days.
She told doctors there that she’d felt a creature moving in her ear, and heard “beating, clicking, and rustling sounds.”
The experience was so disturbing that she hadn’t been able to sleep, Liyin Weng, BS, and Tengchin Wang, MD, of Tainan Municipal Hospital in Tainan City, Taiwan, reported as an “Images in Clinical Medicine” in the New England Journal of Medicine.
Wang told MedPage Today in an email that his first suspicion was a mosquito or a cockroach, since he’d removed those creatures from patients’ ears in the past.
But when he looked into the otoscope, he saw a small spider moving around in the patient’s external auditory canal.
The spider had even molted, leaving behind a tiny exoskeleton, Wang and Weng reported.
“There are reports of ants, moths, cockroaches, and mosquitoes running into the ear canal, but there seems to be no mention of insects molting inside the ear canal,” Wang told MedPage Today.
The spider was identified as Hasarius adansoni, which is commonly referred to as Adanson’s house jumper, a tiny little black jumping spider that’s furred and streaked with white stripes. Wang said these spiders are common in Taiwan.
“It likes to molt in a dark environment, so I guess that’s how it probably hides in human ears at night, then molts,” he wrote in the email.
Wang and Weng removed both the spider and the exoskeleton using a suction cannula placed through an otoscope.
“I didn’t use any drug or solution to kill the spider before the procedure,” he said.
They noted in their report that with larger spiders or insects in the external auditory canal, physicians can first use lidocaine or ethanol to kill the creature before removing it. That strategy would prevent any excessive movement from the insect, and any damage to the structures of the ear.
They warned, however, that liquids shouldn’t be introduced into the ear if the tympanic membrane — also known as the eardrum — has been perforated.
“In my personal experience, patients who have insects inside the ear seldom remove them by themselves successfully,” Wang said. “Such manipulation may irritate the creatures, and they will scratch the eardrum and canal skin.”
The woman’s symptoms went away as soon as the spider and its exoskeleton were removed, Wang and Weng reported.
New England Journal of Medicine
Source Reference: Weng L, Wang T “A spider and its exoskeleton in the ear canal” N Engl J Med 2023; DOI: 10.1056/NEJMicm2307942.