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Clinical Procedures > Otolaryngologic and Dental Procedures
Foreign Body Removal, Ear
Article Last Updated: Jun 27, 2008
AUTHOR AND EDITOR INFORMATION
Section 1 of 14  
Author: Angela On-Kee Kwong, BA, MD, Attending Physician, Department of Emergency Medicine, Albert Einstein-Jack D Weiler Hospital
Coauthor(s):
Jennifer M Provataris, MD, Clinical Instructor, Attending Physician, Department of Emergency Medicine, Jacobi Medical Center and North Central Bronx Hospital
Editors: Prajoy P Kadkade, MD, Assistant Professor, Department of Otolaryngology and Communicative Disorders, North Shore University Hospital-Long Island Jewish Hospital System, Albert Einstein College of Medicine; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Author and Editor Disclosure
Synonyms and related keywords:
ear foreign body, foreign body in the ear canal, removal of ear foreign body, ear pain, ear problems, tympanic membrane perforation, cockroaches, button batteries, tympanic perforation, ear foreign body removal, insect in ear, ear stuffing, tympanic membrane, TM, TM perforation, hearing aid batteries, ear irrigation, mechanical extraction, ear suction, external auditory canal, auditory canal abrasions
The removal of foreign bodies from the ear is a common procedure in the emergency department. Children older than 9 months often present with foreign bodies in the ear; at this age, the pincer grasp is fully developed, which enables children to maneuver tiny objects.
In adults, insects (eg, cockroaches, moths, flies, household ants) are the foreign bodies most commonly found in the ear. Rarely, other objects have been reported (eg, teeth, hardened concrete sediments, illicit drugs, plant material).1,2,3 Some persons from Mexico and Central America reportedly insert leaves and other plant material into their ears as a form of native remedy.4 Also, some adults with psychiatric disorders present to the emergency department with foreign bodies lodged in their ears as a form of self-mutilation called ear stuffing.5
In children, the range of foreign bodies is extensive. Food particles (eg, candy, vegetable matter, beans, chewing gum) and other organic material (eg, leaves, flowers, cotton pieces) are commonly encountered. Inorganic objects such as small toys, beads, pencil erasers, and rocks are also common.
The prompt removal of foreign bodies from the ear is indicated whenever a well-visualized foreign body is identified in the external auditory canal and an uncomplicated first attempt is anticipated.
- The presence of a tympanic membrane (TM) perforation, contact of a foreign body with the tympanic membrane, or incomplete visualization of the auditory canal are indications for urgent-emergent ENT consultation for removal by operative microscope and speculum.
- If button batteries or hearing aid batteries are involved, emergent ENT consultation is always warranted because time-sensitive liquefaction necrosis may lead to subsequent tympanic membrane perforation and further complications. In fact, irrigation should never be attempted in such cases, as it accelerates the necrotic process.6,7
- Local anesthesia is invasive and is not generally used for uncomplicated ear foreign body removal because of the complex innervations of the external ear canal.
- Procedural sedation is sometimes necessary for a patient who is unable to cooperate with the removal procedure. For more information, see Procedural Sedation. Click here to complete a Medscape CME activity on pediatric procedural sedation.
The equipment required depends on the removal method. Typical equipment includes the following:
- Otoscope with removable lens
- Microscopic otoscope
- Nasal speculum
- Headlamp
- Bayonet forceps
- Alligator forceps
- Syringe
- Angiocatheter, 20 gauge (ga)
- Emesis basin
- Soft-tipped suction catheter and suction equipment
- Magnet for metallic foreign bodies
Equipment display.
A patient's external auditory canal is easily visualized in both seated and lateral decubitus positions; cooperative patients can choose whichever position is more comfortable. In adults and young children, gently retract the pinna superiorly and posteriorly to straighten the ear canal for optimal visualization. In infants, the pinna may have to be gently retracted posteriorly or even downward for optimal view of the external auditory canal.
Positioning and examining with otoscope.
Techniques appropriate for the removal of ear foreign bodies include mechanical extraction, irrigation, and suction. Practitioners should allow the nature of the foreign body to guide the choice of technique. Irrigation is contraindicated for organic matter that may swell through osmosis and enlarge within the auditory canal. Insects, organic matter, and objects with the potential to become friable and break into smaller evasive pieces are often better extracted with suction than with forceps. Live insects in the ear canal should be immobilized before removal is attempted. Mineral oil, microscope oil, and viscous lidocaine have all been used successfully for this purpose.8,9
Mechanical extraction
Position the patient comfortably. Briefly repeat the ear examination while observing the location and depth of the foreign body. Move the otoscope lens to one side and carefully introduce bayonet forceps or alligator forceps through the otoscope lens. Advance the forceps incrementally through the external auditory canal until the foreign body is grasped. Gently withdraw the forceps, with attached foreign body, from the auditory canal. Always check for complete removal of the foreign body, perforation of the tympanic membrane, and abrasions of the auditory canal.
Mechanical extraction with alligator forceps.
Mechanical extraction with bayonet forceps.
Irrigation
To irrigate, first attach a 20-ga angiocatheter to a 60-mL syringe. Warming the irrigation fluid (water or normal saline) greatly enhances patient comfort. Position the patient comfortably and drape the area to keep the patient dry. Position an emesis basin under the affected ear to collect irrigation runoff. Place the flexible angiocatheter tip gently in the external auditory canal. Advancing the tip too far risks damage to the tympanic membrane. With the angiocatheter tip held gently in position, slowly inject irrigation fluid until the foreign body washes out. Always conduct a postprocedural ear examination to confirm complete removal of the foreign body and to check for complications.
Irrigation method.
Suction
Connect the soft-tipped suction catheter to low wall suction and position the patient comfortably. Visualize the foreign body with the otoscope. Maintain the position of the otoscope while retracting its lens to one side. Introduce the catheter through the otoscope and gently advance it incrementally until the foreign body is contacted. Gently withdraw the suction catheter tip and attached foreign body from the external auditory canal. Repeat a postprocedural ear examination to confirm complete removal of the foreign body and to check for complications.
Suction method.
Abandon attempts to retrieve a foreign body if complications arise. If the object migrates farther into the canal or if bleeding, edema, or increasing pain develops, consult an ENT specialist. Repeated attempts to remove a foreign body from the ear may result in infection, perforation, or other morbidity.10,11
- Consider that an underlying illness may have prompted the patient to insert a foreign body into the ear to relieve discomfort such as pain or pruritus.12
- Perform a thorough head, ears, eyes, nose, and throat (HEENT) examination in all patients, since throat pain can refer to the ears.
- Always examine the opposite ear and both nares for additional foreign bodies.
- Always examine the external auditory canal after the removal of a foreign body to identify preexisting or iatrogenic tympanic membrane perforations or abrasions.
- Acetone has been used successfully to remove chewing gum, Styrofoam, and superglue from the ear canal.13,14,15
- Ethyl chloride has been used to remove Styrofoam beads from the ear canal.16
- Reported acute complications of ear foreign body removal include canal abrasions, bleeding, infection, and perforation of the tympanic membrane. Presentation of these complications may be delayed. Retained foreign body particles may cause subsequent formation of granulomas.17
- For the uncomplicated removal of foreign bodies from the ear, neither prophylactic antibiotics nor routine ENT follow-up is indicated.18
- Not all complications are immediately evident. Ensure that the patient or caregiver understands that further treatment is warranted if pain, redness, fever, or discharge develops.
eMedicine.com, Inc: Foreign Bodies, Ear
I would like to thank Melissa Harper and Linda Liu for their wonderful patience and winning attitude in participating with this chapter. I would also like to thank my awesome attending, Dr. Jennifer Provataris, for her infinite encouragement, tireless diligence, wisdom, and creativity in producing this chapter with me.
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Positioning and examining with otoscope. |
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Mechanical extraction with alligator forceps. |
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Mechanical extraction with bayonet forceps. |
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Foreign Body Removal, Ear excerpt Article Last Updated: Jun 27, 2008
Topic originally published: Oct 20, 2006
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