Foreign body in the ear

• small children may put objects such as pips, beads and paper clips in their ears. Adults may get foreign bodies like toothpicks stuck in an attempt to use them to clean wax out of their ears. Foreign bodies in ears are more often seen in the mentally disturbed
• organic foreign bodies are more likely to cause infection.
• keys to successful foreign body removal are adequate visualization, appropriate equipment, a cooperative patient, and a skilled physician (1)
• several points relating to management are noteworthy:
  • removal of the foreign body by syringing is not usually successful.
  • If removal seems impossibly difficult then leave the job to someone with more skill - i.e. refer.
  • an uncooperative patient may necessitate resorting to removal under general anaesthetic.
• after removal the tympanic membrane must be checked - there may be a perforation which must be treated.
• the following should be avoided (2):
  • use of a rigid instrument to remove a foreign body from an uncooperative patient's ear
  • removal of a large insect without killing it first
  • irrigating a tightly wedged seed from an ear canal. Water causes the seed to swell.
  • removal of a large or hard object with bayonet, alligator or similar forceps which may push them farther into the canal
• indications for referral include (1):
  • lack of expertise of clinician in removal of foreign body - the first attempt at removal has the greatest chance of success
  • need for sedation
  • trauma to ear canal or tympanic membrane
  • foreign body is non-graspable
  • foreign body touching the tympanic membrane
  • tightly wedged foreign body
  • sharp-edged foreign body
  • unsuccessful removal attempts

References:

1. Heim SW et al. Foreign bodies in the ear, nose, and throat. Am Fam Physician 2007;76:1185-9.
2. Foreign Body in Ear. National Center For Emergency Medicine Informatics 2007