Retro-auricular Approach in a Middle Ear Drop Weld. An Unusual Approach to an Unusual Injury

Objective: To describe a rare case of middle ear foreign metal body and its management. Patient: A 47 years old male welder presenting to Emergency Department with left othalgia and mild hearing impairment after a metallic spark has entered his ear. The patient underwent clinical evaluation, pure-tone audiometry and HRCT scan, that showed inferior eardrum perforation with purulent discharge, left moderate mixed type hearing loss and the presence of a foreign body in the protympanum near the carotis. Results: After one month of local and systemic therapy the patient underwent surgery although his ear was still discharging. The metallic spark was removed with a retro-auricular approach and underlay myringoplasty performed. After 12 weeks from surgery the eardrum was intact and air-bone gap partially closed. Conclusion: Time and technique of surgery are the key-factors and early single-step surgical intervention should be the treatment of choice in order to get better results. Using earplugs must be recommended in order to avoid this kind of accidents.