Air rifle pellet injury to the middle ear, a very rare occurence.

INTRODUCTION: Air rifle pellet injuries are relatively common. These injuries often involve the brain, eyes chest or abdomen. It is rare for ENT surgeons to be involved in the care of these patients. CASE REPORT: We present the case of a 38 year old man with a history of an air rifle pellet injury to the left ear. Presenting symptoms included bleeding per ear, otoalgia, hearing loss and tinnitus. Imaging and surgical exploration demonstrated a metallic pellet in the left petrous temporal bone, within the middle ear and a fracture of the anterior wall of the external auditory meatus with associated tiny metallic fragments. A further surgical exploration was required to remove a bony sequestrum of the anterior canal wall. CONCLUSION: The onset of pain and discharge a few months after the injury may imply the formation of a delayed sequestrum. The possibility of an implantation cholesteatoma should also be considered.