Say that again? The seed that grew inside an ear

Dr Nahim Shahid works at the Ear, Nose and Throat department at Rawal Medical College Islamabad. Here he presents us with a very unusual case report...

A commonly-encountered condition in the Ear, Nose and Throat departments in many hospitals is a foreign body in the ear. It may be living or dead, vegetable or non-vegetable. Seeds, grains, pulses and betel nuts are frequent vegetable foreign bodies in the external ear canal (External Auditory Canal - EAC). But it's very unusual for a long-standing foreign-body seed to grow inside the ear into a plant. Considering the rarity of the situation, we present this case of a bean germinated as an implanted seed. To the best of our knowledge, and following an extensive literature search, we believe that a similar case has never been reported previously.

CASE REPORT

Patient's Profile:

A twenty year-old, mentally sound male visited the ENT clinic of Pak Khaleej medical Centre on the 17th June 2003 complaining of intense itching, intermittent otalgia (meaning pain, or earache), and a sensation of "heaviness" in his right ear over the previous 45 days. There was no previous history of pain in the ear, or discharge from the ear.

On examination:

The pinna (external part of the ear) was found to be normal. But the ear was found to contain a "U" shaped, rope-like, greenish structure in the external ear canal (see figure, right). A preliminary diagnosis of a foreign body in the right ear was made. At this stage, that it could be a growing seed was not considered.

The object was removed without the need for anaesthesia and without complications. At this point it was clearly a growing seed, with green stalk, multiple primary roots embedded in the wax near the ear drum, and leaves were attached to the stalk. Two halves of the seed coat were seen lying near the ear drum, embedded in wax.

DISCUSSION

Foreign bodies, which may be animate, inanimate, or organic materials, in the ear is a frequent finding in patients attending ENT clinics. Removal is usually achieved without any complication, if done by an experienced person with proper preparation in the operating theatre.

Animate foreign bodies constitute a significant proportion of cases and include flying and crawling insects like cockroaches, ants, mosquitoes or even baby lizards. One previous case report even describes an insect reaching the middle ear cavity through a perforation in the ear drum. A live baby lizard was removed by the author from another patient's ear canal about five years previously.

The list of inanimate foreign bodies is very long and each ENT specialist has his own experience dealing with these. This group can include silicon, concrete, chewing gum, alkaline batteries, superglue, teeth and cement.

A significant number of foreign bodies are organic, and seeds are especially common. These may induce local skin reactions when they absorb moisture and swell. Removal best conducted under general anaesthesia.

For seeds to grow, an appropriate environment is necessary, including an appropriate temperature, moisture and some form of "soil". The temperature in late May or early June when this patient presented to us would have been about 40 degrees centigrade. The patient worked in a warehouse dealing with grain. This environment might have provided humidity sufficient for the seed to grow. Routine daily head washes and baths acheive the same end and may have further aggravated the situation.

The primary roots of the seedling were found embedded in the specks of wax lying near the ear drum. Chemicals in the wax might have acted as fertiliser. The wax, plus the dust, may have provided a soil-like substrate to support the germination of the seed. How the seed got into the ear in the first place, we don't know.

To our knowledge, no such similar cases have been reported in the literature, so here we present the first example of a seed germinating and growing as a foreign body in the ear.