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Cotton bud in external ear canal causing necrotising otitis externa and subdural abscess
  1. Alexander Charlton,
  2. Noor Janjua and
  3. Darius Rejali
  1. Department of Otolaryngology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  1. Correspondence to Alexander Charlton, alex.charlton{at}


Necrotising otitis externa (NOE) is an infection originating in the soft tissues of the external auditory canal (EAC) spreading to the surrounding bone and rarely causing intracranial complications. It is usually caused by Pseudomonas aeruginosa and has historically occurred in elderly patients with diabetes or immunodeficiency. EAC foreign body is a risk factor for otitis externa but has not been described in NOE. A healthy 31-year-old man presented with new-onset seizures and worsening left-sided otalgia and otorrhoea. Brain imaging revealed left temporal subdural abscesses superior to the petrous bone. A retained cotton bud was identified in the left EAC, along with osseocartilaginous junction and mastoid granulation tissue. The foreign body was removed; a cortical mastoidectomy performed and intravenous antibiotic administered. At 10 weeks, the patient remained well, with no neurological deficit and no residual ear symptoms, and CT demonstrated complete resolution of the intracranial abscesses.

  • ear nose and throat/otolaryngology
  • bone and joint infections
  • otitis
  • neurosurgery
  • headache (including migraines)

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  • Contributors All named authors have contributed to the content of this article. ARC performed literature review and did the majority of writing for the piece. NJ reviewed and made alterations/recommendations to the piece. DR reviewed and made alterations/recommendation to the piece as an experienced otologist with extensive experience with necrotising otitis externa.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.