Foreign bodies in the ear

Various objects may be found, including toys, beads, stones, folded paper, cotton buds, insects or seeds. Most ear and nose foreign bodies can be removed with minimal risk of complications. Common removal methods include use of forceps, water irrigation, and suction catheter¹ .

Epidemiology

• Foreign bodies of the ear are relatively common.

• They are seen most often in children² .

Presentation

• Most older children and adults will know that there is something in their ear but sometimes a foreign body may get into the external ear canal without the patient realising.

• The patient may present with pain, deafness or discharge. Live insects may cause a buzzing in the ear.

• The appearance will vary according to the object and length of time it has been in the ear:
  

  • An inanimate object that has been in the ear a very short time presents with no abnormal finding other than the object itself.

  • Pain or bleeding may occur with objects that abrade the ear canal, from rupture of the tympanic membrane, or from the patient's attempts to remove the object.

  • With delayed presentation, erythema and swelling of the canal and a foul-smelling discharge may be present.

Management

A great deal of care is required in order not to push the object deeper into the ear canal and not to damage the ear canal. There is a high failure rate in removal of foreign bodies from the ear³ .

• Insects should be killed prior to removal, using 2% lidocaine.

• Remove batteries or magnets as soon as possible to prevent corrosion or burns. Do not crush a battery during removal.

• Adhesives (eg, Super Glue®) may be removed manually within 1-2 days once desquamation has occurred. Referral to an ear, nose and throat specialist is required if an adhesive is in contact with the tympanic membrane.

Methods for removal

• Forceps or hook: grasp the object with forceps, or place a hook behind the object and pull it out.

• Irrigation is often effective. Irrigation with water is contra-indicated for soft objects, organic matter or seeds (which may swell and increase the level of pain and difficulty to remove if exposed to water).

• Suction with a small catheter held in contact with the object may be effective.

• Enhancements employed in secondary care include the use of a binocular microscope and the use of skin closure glue⁴ .

Referral to an ear, nose and throat specialist

It is advisable only to have one attempt at removal in children before referring, in order to decrease the distress caused. Complications and morbidity often occur from repeated attempts at removal of the foreign body⁵ . Referral is also indicated:

• If the patient requires sedation.

• If there is any difficulty in removing the foreign body.

• If the patient is unco-operative.

• If the tympanic membrane has been perforated.

• If an adhesive is in contact with the tympanic membrane.