Inadvertent insertion of hearing aid impression material into the middle ear: Case report and implications for future community hearing services

Abstract

INTRODUCTIONThe creation of ear moulds for hearing aids is generally considered a safe and routine procedure for trained professionals. In the literature there are reports of otological complications caused by hearing aid mould impression material in the middle ear cavity but such complications are considered rare.PRESENTATION OF CASEWe present the case of a patient in whom impression material entered the middle ear through a perforation of the tympanic membrane during the process of making a hearing aid mould and review how this was managed.DISCUSSIONWe discuss how many aspects of the British Society of Audiology guidelines were not followed during this procedure and make recommendations as to how independent community practitioners need to be closely supervised with regular review to minimise the risks of such complications.CONCLUSIONOur report demonstrates how a serious otological complication from the creation of a hearing aid impression in a community based private hearing clinic was managed. The reporting of such complications is rare but the incidence is likely to be much higher than the literature would suggest. We recommend and advise how these adverse incidents may be minimised and managed through competency reviews and formal referral links from community centres to hospital otolaryngology/audiology departments.

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

“…Twenty-two publications were included for analysis. 4-25 In total, 49 ears, including this study, were evaluated (Table 1). In the majority of the other studies, the ear impression was taken for hearing aids.…”

Impression Material in the External and Middle Ear: an Overview of the Literature and a Stepwise Approach for Removal

“…Extra caution should be taken in the presence of risk factors such as tympanostomy tubes, tympanic membrane perforations, and retraction pockets, and when the patient has a history of previous surgery, such as mastoidectomy [1] . The first case report was published in 1983 [6] , and a literature search revealed 40 similar cases published in English, varying only in external or also middle ear involvement [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . Table 1 provides an overview of those 34 cases in the literature with middle ear involvement and for whom the respective (surgical) removal procedures were described.…”

“…All of these relatively acute symptoms may be considered alarming, and referral would therefore be indicated. Notably, in cases of delayed presentation, symptoms such as perforation, persistent discharge, and conductive hearing loss may mimic chronic otitis media (n=4) [10,11] .…”

Expect the unexpected

“…Use of cotton or gauge plugs tied to string and otostop are crucial in preventing iatrogenic complication of aspiration or lodgment of impression material. The otological complications caused by hearing aid mold impression material in the middle ear cavity have been reported in the literature,[ 1 2 3 4 ] but to the best of my knowledge, no case of impression material lodgment in the nasal cavity has been reported. Such complications might have happened, but are not evident in the literature may be due to underreporting.…”