Cardiac depression on syringing the ear. A case report

Area of Science:

• Otolaryngology
• Cardiology
• Neuroscience

Background:

• Ear canal cleaning procedures, such as syringing, are common medical interventions.
• The vagus nerve plays a crucial role in both the autonomic nervous system and cardiovascular function.
• Cholinergic nerve stimulation can manifest in various physiological responses.

Observation:

• During ear syringing, a patient experienced sudden cardiac arrest.
• The event was immediately preceded by stimulation of the external auditory meatus and tympanic membrane.
• The patient exhibited additional signs consistent with cholinergic nerve overstimulation.

Findings:

• The cardiac arrest was strongly presumed to be a vasovagal response triggered by ear canal stimulation.
• The vagus nerve's innervation of both the ear canal and cardiac muscle supports this hypothesis.
• The patient's recovery was swift, occurring within a minute following external cardiac massage.

Implications:

• This case underscores the potential for otologic procedures to induce significant cardiovascular events.
• Awareness of the vagovagal reflex is critical for clinicians performing ear canal interventions.
• Prompt recognition and management, including cardiac massage, are vital for patient outcomes in such rare occurrences.