Today would have been my first day of observing in the clinic, but no patients were scheduled during my time. I did find a very interesting article dealing with ear mold impressions on ears with abnormalities. The article discusses six cases in which ear mold impression material entered the middle ear and/or mastoid cavities requiring surgical removal.
The first patient went to a hearing aid distributer to be fit and ended up in a world of medical trouble concerning the ear. The patient had a perforation in his left tympanic membrane. The ear mold impression entered through the perforation, filled the middle ear space (surrounded ossicles), and even entered the eustacian tube. Tympanoplasty and rebuilding of the ossicles took place, but the patient resulted in a mixed loss.
The second patient suffered from an attic retraction pocket in the left ear. The ear mold material became attached in the pocket. An ENT tried to get the material out with no success. The patients hearing had decreased. A CT scan revealed issues in the middle ear and mastoid. A tympanomastoidectomy was recommended, but the patient said no and never returned.
Patient 4 had undergone a mastoidectomy. Precautions were taken to avoid issues, but the ear mold material did get lodged in the mastoid cavity. The material was able to be removed, and no major problems occured.
Patient 5 acquired a perforation in the tympanic member from the impression material. The material was also touching the ossicles. The patient did not want surgery. They ended up getting cholesteotoma. Many more complications occured creating major problems. After surgeries and management, the patients TM healed, but significant hearing loss occured.
Patient 6 had PE tubes. The material went through the PE tubes into the middle ear. A surgery was performed, but the perforation left in the TM did not heal. A second surgery proved to be successful.
In most cases, fitting ear molds results in little complications. One must be aware of pre-existing conditions which could complicate the procedure. I felt this article was very interesting. I have listed the information for the article below if you wish to read for yourself!
Jacob, A., Morris, T.J., & Welling, B. (2006). Leaving a lasting impression: Ear mold
impressions as middle ear foreign bodies. Annals of Otology, Rhinology, & Laryngology, 115
(12), 912-916.
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6 comments:
This makes me a little scared to do ear mold impressions! I'm sure most of these problems aren't common but it will definitely make me a lot more cautious. I was particularly interested in the patient with the PE tubes. Do you know how common it is for impression material to enter through these tubes?
I did not come across an actual statistic. I'm sure that the situation is not common, but the occurence should make practitioners more cautious!
This also makes me a little scared after reading this. This is definately an article all first year graduates should read, just to imform them on all the precautions that should be taken before making impressions for an ear with abnormal TM's. I'm courious to know how the patient with the impression material stuck to her retraction pocket ever got it removed or if she had it removed.
Thank you for posting this article Gina. It makes me feel like I am not the only one that these things happen to :)
I thought you might be interested in that article Dr. Payne! haha
Ya, it happens but it never happened in my experience. It is better to put a string with cotton first and then put impression material.
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