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3.05 Foreign Body in Ear

Presentation
Sometimes a young child admits to putting something like a bead or a bean in his ear,
or an adult witnesses the act. Sometimes the history is hidden and the child simply
presents with a purulent discharge, pain, bleeding or hearing loss. Most dramatically, a
patient arrives at the emergency department panic-stricken because he feels and hears
a bug crawling around in his ear.
What to do:
If there is a live insect in the patient's ear, simply fill the canal with mineral oil
(e.g., microscope immersion oil). Lay the patient on his side and drop the oil
down the canal while pulling on the pinna to remove air bubbles. This will
suffocate the intruder, so it can be removed using one of the techniques below.
The least invasive methods should be tried first.
Water irrigation is often effective for safely removing a foreign body that is not
tightly wedged in the ear canal. This can be accomplished with an irrigation
syringe, Water Pik, or a standard syringe and scalp vein needle catheter cut
short (see above). Tap water or normal saline at body temperature can be used
to flush out the foreign body by directing the stream along the wall of the ear
canal and around the object, thereby flushing it out.
If the object is light and moves easily, attempt to suction it out with a standard
metal suction tip or specialized flexible tip, whichever can make a vacuum seal
on the foreign body.
If a hard or spherical foreign body remains in the ear canal, and the patient is
able to hold still, you can attempt to roll it out with a right-angle hook, ear
curette or wire loop. Stabilize the patient's head and fix your hand against it,
holding the instrument loosely between your fingers to reduce the risk of injury
should the patient move suddenly. Under direct visualizaton through an ear
speculum, slide the tip of the right-angle hook, ear curette or wire loop behind

the object (rotate the hook to catch) and then roll or slide the foreign body out
of the ear.
Alligator forceps are best for grasing soft objects like cotton or paper. The
wooden shaft of a long cotton swab can be armed with one drop of
cyanoacrylate (Super Glue) to adhere to a smooth, clean, dry foreign body.
Touch it to the foreign body, hold for ten seconds, then pull. Try not to glue the
stick to the wall of the ear canal, but if you do, be thankful for cerumen
(above).
What not to do:
Do not use a rigid instrument to remove an object from an uncooperative
patient's ear. An unexpected movement might lead to a serious injury of the
middle ear.
Do not attempt to remove a large bug or insect without killing it first. They tend
to be wily, evasive little creatures well equipped for fighting in tunnels. In the
heat of battle, the patient can become terrorized by the noise and pain and the
instrument that you are using is likely to damage the ear canal.
Do not attempt to irrigate a tightly wedged bean or seed from an ear canal. The
water may cause the bean to swell.
Do not attempt to remove a large or hard object with bayonet or similar forceps.
The bony canal will slowly close the forceps as they are advanced and the
object will be pushed farther into the canal. Alligator forceps are designed for
the canal, but even they will push a large, hard foreign body farther into the ear.
Discussion
The cutaneous lining of the bony canal of the ear is very sensitive and is not much
affected by topical anesthetics. If your patient is an uncooperative child, you might
make one cautious attempt at removal under conscious sedation (see below) with firm
head restraint, but your most prudent strategy is to schedule elective removal under
general anesthesia by a specialist.
Irrigation techniques and the use of the ear curette can also be effective in removing
excess cerumen from an ear canal (see above). Whenever an instrument is used in an
ear canal it is a good idea to warn the patient or parents beforehand that there may be
a small amount of bleeding.

There should be no delay in removing an external auditory canal foreign body when
there is an obvious infection or when the foreign body is a disk batters. On contact
with most tissue, this type of alkaline battery is capable of producing a liquefactive
necrosis extending into deep tissues. After removal, the canal should be irrigated to
remove alkalai residue. Styrofoam beads can be instantly dissolved by spraying them
with a small amount of ethyl chloride. Lidocaine has been shown to make
cockroaches exit the ear canal, but this may be unpleasant for the patient. On
telephone consultation, patients can be instructed to use cooking or baby oil to kill an
intra-aural insect, which can then be removed in a subsequent office visit.
Complications of foreign body removal include trauma to the skin of the canal, canal
hematoma, otitis externa, tympanic membrane perforations, ossicular dislocations and
facial nerve palsy.
References:
Bressler K, Shelton C: Ear foreign-body removal: a review of 98 consecutive
cases. Laryngoscope 1993;103:367-370.
O'Toole K, Paris PM, Stewart RD, Martinez R: Removing cockroaches from
the auditory canal: controlled trial. N Eng J Med 1985;312:1197.
Leffler S, Cherney P, Tandberg D: Chemical immobilization and killing of
intra-aural roaches. An in-vitro comparative study. Ann Emerg Med
1993;22:1795-1798.
Brunskill AJ, Satterwaite K: Foreign bodies. Ann Emerg Med 1994;24:757.
Skinner DW, Chui P: The hazard of button-sized batteries as foreign bodies in
the nose and ear. J Laryngol Otol 1986;100:1315- 1319.
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