Sometimes you find life in strange places...
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 being found inside the ear. It may be living or dead, vegetable or non-vegetable. Seeds, grains, pulses and betel nuts are commonly seen vegetable foreign bodies in the external ear canal (External Auditory Canal EAC). 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 in the soil would.
To the best of our knowledge and with extensive search in medical literature, a similar case has never been reported nationally or even internationally.
A twenty year-old, mentally sound male visited the ENT clinic of Pak Khaleej medical Centre on the 17th June 2003 with the complaints;
- intense itching
- occasional pain
- heaviness in right ear of the last 45 days.
There was no previous history of pain in the ear, or discharge from the ear.
a. The pinna (external part of the ear) was found to be normal.
b. The ear was found to be housing a “U” shaped, rope-like, greenish structure in the external ear canal.
Preliminary diagnosis of a foreign body in the right ear was made. By that time it never came to my mind that it could be a growing seed.
The plant was removed without any anesthesia and without any complication. It was 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.
Finding a foreign body in the ear is frequent in patients attending ENT clinics, which can be animate, inanimate, and organic. Removal is always without any complication if done by an experienced person with proper preparation in the operation theatre.
Animate foreign bodies constitute a significant percentage, which include all types of flying and creeping insects like cockroaches, ants, mosquitoes or even baby lizards. A case has been reported in the literature of an insect reaching in the middle ear cavity through the ear drum perforation. A live baby lizard was removed by the author about five years back.
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, a tooth and cement.
A good number of foreign bodies are organic, especially seeds, which may induce local skin reaction when these absorb moisture or swell up due to chemicals contained in them. Removal is done under general anesthesia.
For the seeds to grow appropriate environments are absolutely necessary such as
1. appropriate temperature
The temperature in late May or early June is about 40 degrees centigrade. The patient was an indoor worker in a warehouse dealing with the grains. This environment might have provided humidity sufficient enough for the seed to grow. Routine daily head washes/baths can do the same job and further aggravate 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 fertilizer. The wax plus the dust might have provided a `soil like` environment for the germination of the seed.
Since no such is reported in the literature, the topic of a growing seed as a foreign body in the ear is being presented for comments and a topic for research.
A student in my class had this exact thing happen to him last year..... I verified with the teachers and it was indeed true. The child had stuck the bean in his ear and it was unable to be removed. A week later it sprouted and the tiny roots actually helped to push the bean out. (Glynda Simmons, Ottawa, Canada.) Glynda Simmons, Thu, 21st Jan 2016