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63-Year-Old Female with Left Ear Pain
This case features a 63-year-old female presenting with left ear pain, ultimately diagnosed with a foreign body in the external auditory canal — pencil lead.
Imaging overview:
Axial and coronal bone CT of the temporal bones demonstrates a linear hyperdensity within the left external auditory canal with surrounding soft tissue density, consistent with a retained foreign body. Clinically, a large amount of wax was noted in the left ear canal, and an object identified as pencil lead was successfully removed using an ear curette. The tympanic membrane was found to be scarred.
Clinical insight:
External auditory canal foreign bodies are most commonly encountered as incidental findings on CT studies obtained for other indications. The density of a foreign body on CT is a key feature aiding identification — metallic and graphite objects such as pencil lead appear as linear hyperdensities, while plastic and glass foreign bodies may be CT occult and therefore missed on imaging alone. Awareness of this limitation is important when evaluating patients with ear pain and a history of potential foreign body insertion, as clinical examination remains essential for diagnosis and management.
Case courtesy of Isaac Anthony, MS3, and Rick Wiggins, MD, University of Utah.