Acute otalgia: a case report of mature termite in the middle ear.

Acute otalgia during childhood is one of the most common complaints in general ENT practice. It may occur as a result of acute otitis externa, otitis media or a foreign body. Animate foreign body in the ear canal or in the middle ear usually results in otalgia and hearing loss. We present a rare case of a living mature termite in the middle ear of a 9-year-old girl complaining of intermittent attacks of otalgia associated with a loud cracking sound in the left ear. In this case, a small perforation of the tympanic membrane without a history of previous trauma, infection, or evidence of a foreign body in the external ear raises a suspicion. A careful, time-consumed microscopic examination could show the living creature in the middle ear. Immediate immobilization and removal of the living foreign body are imperative. In conclusion, tympanic membrane perforation and intermittent severe otalgia without history of otitis may lead to a suspicion of any insects in the middle ear.