{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:53:48Z","timestamp":1791266028644,"version":"4.1.0"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011324","name":"Qingdao University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011324","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Tick bites in the external auditory canal are rare but can pose diagnostic and management challenges in primary care settings. This case series aims to highlight diagnostic challenges and public health implications of otoacariasis in East China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed three cases of tick bites that initially posed diagnostic and management challenges at primary hospitals in Qingdao, Jinan, and Shanghai. Clinical data, including presentation, initial diagnostic assessment, treatment, and follow-up, were extracted from electronic medical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Case 1: a 70-year-old female with an engorged tick abdomen mistaken for the tympanic membrane. Case 2: a 3-year-old girl with retained tick mouthparts after forceful removal. Case 3: a 5-year-old girl with a tick on the tympanic membrane misidentified as a common insect. Key diagnostic clues included tick morphology, dark red feces, and leg movement. Topical 2% lidocaine effectively immobilized ticks for atraumatic extraction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These cases highlight a diagnostic and management gap in primary care settings in East China, underscoring the need for enhanced physician education and public awareness as a key public health strategy to promote early recognition and improve patient outcomes in the region.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1946165","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:21:40Z","timestamp":1791264100000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Otoacariasis in East China: a case series of three tick bites with diagnostic and management challenges"],"prefix":"10.3389","volume":"14","author":[{"given":"Yongzhi","family":"Niu","sequence":"first","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxiu","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Eye and ENT Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaixuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Che","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoting","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhui","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Qingdao University","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00083-18","article-title":"Emerging tick-borne diseases","author":"Madison-Antenucci","year":"2020","journal-title":"Clin Microbiol Rev."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e7394","DOI":"10.1097\/MD.0000000000007394","article-title":"Human otoacariasis caused by Amblyomma testudinarium: diagnosis and management: case 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