Clinical Approach After Complicated Ear Mold Fitting: A Case Series of Six Patients and Evaluation of Literature

Abstract

Objectives:Insertion of mold material into the middle ear is a complication of molding procedure for ear impression. These cases are referred to an ENT specialist. There is no standardized approach to this problem. Literature shows different clinical strategies. The aim of this study is to share our experience and to analyze the adverse outcome of different clinical approaches.Methods:A case series of six patients with molding material inside the middle ear after complicated molding procedure for swimming earplugs are described. Additionally, available literature was reviewed to analyze results of the clinical approach after iatrogenic molding procedures. Forty-nine ears were included.Results:In-office removal of the material is associated with a significant risk of adverse outcome if the eardrum cannot be examined. This also accounts for ossicular involvement.Conclusions:Temporal bone CT is advised in patients after complicated ear mold fitting if the tympanic membrane cannot be examined completely or the middle ear is involved. Blind removal should be avoided. Retroauricular transcanal tympanotomy or transmastoidal tympanotomy with facial recess approach is best practice in case the mold material has entered the middle ear. A clinical treatment algorithm is presented.

Foreign Body Complications in Ears due to Mishandled Hearing Aid Fitting and Proposed Clinical Guidelines to Address the Complications

“…Van den Boer et al 3 reviewed 49 cases of middle ear foreign bodies to compare different clinical approaches and their outcomes. Among all 12 in-office removal attempts without CT imaging, only one attempt was successful.…”

“…However, when done inappropriately, it can cause severe damage, including conductive hearing loss, sensorineural hearing loss, ossicular dislocation, perilymph fistula, vestibular dysfunction, and persistent tympanic membrane (TM) perforation. 1 2 3 4 …”

An unusual case of ear mould impression material as a foreign body in the middle ear: case report

“…They also recommended canaloplasty as a useful approach for the removal of a foreign body in the hypotympanum with a prominent anterior canal wall. 7 Katarkar et al . preferred a post-aural approach, as it provides wide exposure of the medial part of external auditory meatus and middle ear.…”

“…van den Boer et al recommended several surgical approaches for foreign body removal from the middle ear. 7 Forty-nine ears with similar case scenarios were analysed. In their study, in-office removal attempts without highresolution computed tomography of the temporal bone were described in 12 patients, of which only 1 was successful.…”

“…They also recommended canaloplasty as a useful approach for the removal of a foreign body in the hypotympanum with a prominent anterior canal wall. 7 Katarkar et al preferred a post-aural approach, as it provides wide exposure of the medial part of external auditory meatus and middle ear. 8 • Silicone impression material as a foreign body in the middle ear is a rare complication of an ear moulding procedure • Symptoms include otalgia, aural fullness, otorrhoea, vertigo, facial palsy and accelerated hearing loss • Surgical intervention may be needed to remove the foreign body from the middle ear • An otolaryngologist's opinion is beneficial prior to hearing aid fitting…”