A Man Cleaned His Ears with a Cotton Swab. Then He Got an Infection in His Skull.
A man developed a severe infection in his ear canal from a cotton swab that spread to the lining of his brain. Above, a brain scan showing two abscesses (marked with arrows) in the lining of the man's brain.
Credit: BMJ Case Reports.

A man in England has sworn off cleaning his ears with cotton swabs after developing a potentially life-threatening infection that not only affected his hearing, but also spread to the lining of his brain and caused neurological symptoms, according to a new report of his case.

The 31-year-old man's troubles began when the tip of a cotton swab got stuck inside his ear canal, although he told doctors that he wasn't sure exactly how or when this happened.

A bit of cotton left in the ear may sound harmless, but in this case, it wreaked havoc. [27 Oddest Medical Case Reports]

The man developed a severe bacterial infection that started in his ear canal, progressed into the bone at the base of his skull and then moved upward, into the lining of his brain, the meninges, said lead author Dr. Alexander Charlton, a member of the team of ear, nose and throat specialists involved in the patient's treatment at University Hospital Coventry in England.

Even though the infection didn't enter the man's brain — it didn't progress beyond the lining — it was clearly causing neurological symptoms. The man was rushed to the emergency room after experiencing a seizure and collapsing, according to the case report.

Charlton told Live Science that he suspects that either toxins from the bacterial infection or pressure on the brain from the infection triggered the seizure.

The man's symptoms, however, started long before his seizure occurred, according to the report. He had been experiencing pain and discharge from his left ear for about 10 days prior to the seizure and had experienced headaches on the left side of his head that were so severe, they made him vomit. In addition, he had started having trouble remembering people's names.

But the problems in the man's ear were nothing new; he told doctors that he had experienced left ear pain and hearing loss over the past five years and had been treated twice for severe ear infections on the same side.

When he came to the hospital, doctors gave him a CT scan to examine his brain; the images revealed two abscesses, or inflamed areas filled with pus, in the bones at the base of his skull, adjacent to his left ear canal. This signaled to doctors that although the infection may have begun inside the man's ear canal, it had spread beyond that area.

The man was diagnosed with "necrotizing otitis externa," or an infection in the soft tissue of the external auditory canal. (The external auditory canal is the portion of the ear canal from the outside of the ear to the eardrum.)

The man's doctors performed a minor surgery to explore his ear canal; during this operation, they located and removed the cotton swab tip that had gone missing. The swab was impacted and surrounded by wax and debris, suggesting that it had been there for some time, Charlton said, adding that it probably contributed to the man's recurrent ear infections over the years, culminating in the particularly severe episode.

The man spent nearly a week in the hospital and needed two months of intravenous and oral antibiotics to treat the infection, but he had no long-term hearing or thinking problems.

And, perhaps unsurprisingly, he was advised to never use cotton swabs in his ears again. "They can only cause problems," Charlton said, noting that cotton swabs have been linked to ear infections, punctured eardrums and impacted ear wax.

The case was published online on March 6 in the journal BMJ Case Reports.

Originally published on Live Science.