Temporomandibular joint fistula into the external auditory canal is a very rare condition. We report a case of spontaneous fistula which presented with repeated episodes of clear fluid otorrhoea and ear infection.

A 53-year-old woman complained of occasional episodes of clear fluid otorrhoea from the right ear followed by infection. Otoscopic examination showed a normal tympanic membrane and normal skin in the external auditory meatus. Otomicroscopy showed a small punctum on the anteroinferior part of the meatus. Computed tomography identified a foramen of Huschke. Surgery revealed a fistula between the meatus and the temporomandibular joint, which was successfully resolved.

This report presents a rare case of a fistula between the temporomandibular joint and the external auditory meatus, associated with Huschke's foramen. Such a defect can be quite difficult to detect. It should be suspected in cases of chronic otorrhoea when neither middle nor external ear disease is apparent. Surgery is usually successful, and is advised in cases with repeated complications.

Bacterial biofilm formation has been implicated in the high incidence of persistent otorrhoea after tympanostomy tube insertion. It has been suggested that the tube material may be an important factor in the persistence of such otorrhoea. Development of methicillin-resistant Staphylococcus aureus otorrhoea after tympanostomy tube placement is a growing concern. We evaluated the effect of using vancomycin and chitosan coated tympanostomy tubes on the incidence of methicillin-resistant Staphylococcus aureus biofilm formation in vitro.

Three sets each of vancomycin-coated silicone tubes (n = 5), commercial silver oxide coated silicone tubes (n = 5) and uncoated tympanostomy tubes (as controls; n = 5) were compared as regards resistance to methicillin-resistant Staphylococcus aureus biofilm formation after in vitro incubation.

Scanning electron microscopy showed that the surfaces of the silver oxide coated tubes supported the formation of thick biofilms with crusts, comparable to the appearance of the uncoated tubes. In contrast, the surface of the vancomycin-coated tympanostomy tubes was virtually devoid of methicillin-resistant Staphylococcus aureus biofilm.

Vancomycin-coated tympanostomy tubes resist methicillin-resistant Staphylococcus aureus biofilm formation. Pending further study, such tubes show promise in assisting the control of methicillin-resistant Staphylococcus aureus biofilm formation.