Sir,The recent report on otorrhagia bleeding due to leech bite is very interesting.[1] Askari et al. concluded that “Leech infestation is a rare cause of otorrhagia and should be suspected in the endemic region in all of unusual bleeding; it can be diagnosed and treated by exact inspection and removal.”[1] Indeed, the leech infestation in the Ear-Nose-Throat (ENT) tract is sporadically seen in remote area of tropical countries. The root cause is usually due to the drinking of contaminated water. In Thailand, there are sporadically cases of ENT bleeding due to leech infestations, but the cases are usually not scientifically reported (some cases in the local document have the long history of infestations, more than three months: Thai Rath, 2012-11-04). Based on Thai experience, the intranasal leech infestation is usually seen in rural ethnic patients. Most cases were children and had the history of diving in the stream in the forest.[23] The chief complaint of the indexed cases included nasal congestion and occasional epistaxis.[3] Removal using alligator forceps and a rigid endoscope is the main therapeutic method.[23] In addition to the intranasal leech infestation, the other reports from Thailand on leech bit are usually in female genitourinary tract.[45] The important consideration is the good history-taking and physical examination to determine the infestation.