To differentiate a tick from another foreign body in the outer ear or on the tympanic membrane, ask whether the patient has heard the sound of twigs or sticks breaking. If so, use one or two drops of 1% lidocaine followed by mineral oil to flush the tick out. Next, send the tick out for identification and start treatment for Lyme disease if appropriate (not for attachment less than 48 hours). The antibody test may not be positive for four to six weeks.
—Jan Morgan, FNP, BC, Hoodsport, Wash. (122-14)