Amblyomma testudinarium: A Rare Foreign Bodies in the Ear that

Needs to be Alerted in Agricultural Countries

1
Mizan Maulana and 2Yudha Nurdian
1Student,Faculty of Medicine, University of Jember, Indonesia
2Facultyof Medicine, University of Jember, Indonesia
Corresponding author: Mizan Maulana, zan1314.mm@gmail.com, 152010101115@students.unej.ac.id

Abstract
Background
In an otolaryngology practice, the accidental entry of foreign bodies in the ear canal is
common. But, otoacariasis is a very rare condition which the foreign body is an
arthropod of the Acari subclass, be it a mite or a tick. The Amblyomma spp. is known as
the vector of rickettsiosis which usually found in Africa, Southern Europe and Asia. It
mainly infests cattle, goats and wild ruminant. Amblyomma spp. is not frequently found
in human. A person infested by Amblyomma spp. is usually a farmer who are keeping
animals for milk, meat, wool, hide and for farm utilities from an agricultural country.
Amblyomma testudinarium is a carrier of Rickettsia tamurae which cause skin lesions,
erythema, and pain. In a rare case, A. testudinarium infests the ear. The common
symptom of its infestation on external auricle canal (EAC) is itching and otalgia, which
is caused by an enzyme in tick saliva that produces local inflammation, and pain. A.
testudinarium can grow big after sucking blood, therefore it can fully block the EAC and
causes an aural sensation of pressure. A. testudinarium can be in the deeper part of EAC
attaching the tympanic membrane, thus tinnitus may develop. The mouthpart of the tick
may be attached to the skin surrounding the EAC or even the tympanic membrane. This
event can lead to severe morbidity, the tick paralysis. As the ticks feeding, its saliva
which contain neurotoxin reach the facial nerve. The pathophysiology involves a
decrease in presynaptic acetylcholine release during action potential resulting from
influx impairment of the transmembrane sodium at the nodes of Ranvier and nerve
terminals. This clinically manifest as an acute flaccid paralysis in 24 hour followed by
ataxia which is improved rapidly by tick removal. The tick removal should be done
immediately after determining the unattached mouthpart of tick to the EAC or tympanic
membrane. To determine whether the mouthpart is attached or not, otoscopy may be
used. If the mouthpart cannot be determined by otoscopy, Hartman’s forceps may be
used to move gently its body around. The treatment focuses on relieving the itching and
pain, by removing the infesting ticks. Supportive therapy such as ventilation should be
done for patient with paralysis. A hyperimmune dog serum has been used as antitoxin in
severe cases but carries a high risk of adverse reaction. Submerging the ticks with
anesthetic agent (lignocaine 4% or xylocaine 10%) for 5 minutes (until the tick’s
movement stopped) is a common strategy to deal with it although no established
treatment yet. The tick control which is important for preventing its infestation can be
done by using light clothes to make easy to see the ticks, using repellent, minimizing
contact with adjacent vegetation when walking, and reducing the vegetation inside the
house.

Conclusion
The infestation of A. testudinarium is a neglected disease in otolaryngology. It causes
several symptoms including auricular itching, pain and tinnitus. A tick paralysis can be
happened in a rare case. Although it is not hard to treat the infestation of A.
testudinarium, the prevention is more important to avoid morbidity.

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