eMedicine Specialties > Emergency Medicine > Ear, Nose, & Throat

Foreign Bodies, Ear

Robin Mantooth, MD, FACEP, Consulting Staff, Department of Emergency Medicine, Norman Regional Health System; Adjunct Clinical Assistant Professor, Family Medicine, Oklahoma State University; Consulting Staff, Department of Emergency Medicine, Integris Southwest Medical Center; Consulting Staff, Department of Emergency Medicine, Oklahoma University Medical Center; Consulting Staff, Department of Emergency Medicine, Integris Canadian Valley Health Center; Consulting Staff, Department of Emergency Medicine, Saint Anthony Hospital; Consulting Staff, Department of Emergency Medicine, Commanche County Medical Center; Consulting Staff, Department of Emergency Medicine, Claremore Medical Center

Updated: Jul 1, 2009

Introduction

Foreign bodies of the ear are relatively common in emergency medicine. They are seen most often but not exclusively in children.

Various objects may be found, including toys, beads, stones, folded paper, and biologic materials such as insects or seeds.

Clinical

History

Most adults are able to tell the examiner that there is something in their ear, but this is not always true. For example, an older adult with a hearing aid may lose a button battery or hearing aid in their canal and not realize it.
Children, depending on age, may be able to indicate that they have a foreign body, or they may present with complaints of ear pain or discharge.
Patients may be in significant discomfort and complain of nausea or vomiting if a live insect is in the ear canal.
Patients may present with hearing loss or sense of fullness.

Physical

The physical examination is the main diagnostic tool.

Physical findings vary according to object and length of time it has been in the ear.
An inanimate object that has been in the ear a very short time typically presents with no abnormal finding other than the object itself seen on direct visualization or otoscopic examination.
Pain or bleeding may occur with objects that abrade the ear canal or rupture the tympanic membrane or from the patient's attempts to remove the object.
Hearing loss may be noted.
With delayed presentation, erythema and swelling of the canal and a foul-smelling discharge may be present.
Insects may injure the canal or tympanic membrane by scratching or stinging.

Causes

A patient, caretaker, or sibling intentionally places an object in the ear canal and is unable to remove it.
Insects may crawl or fly into the ear.

Differential Diagnosis

Abrasions to ear canal

Cerumen impaction

Hematoma

Otitis externa

Tumor

Tympanic membrane perforation

Workup

No specific laboratory or radiologic studies are recommended. The physical examination is the main diagnostic tool.

Use an otoscope while retracting the pinna in a posterosuperior direction. A head mirror with a strong light source, operating otoscope, or operating microscope also may be used. Refractory objects may require extraction by an ear, nose, and throat (ENT) specialist.

Treatment

Prehospital care

No specific prehospital treatment exists other than transport to a hospital. Occasionally, treating significant pain or nausea may be necessary.

Emergency department care

Patients in extreme distress secondary to an insect in the ear require prompt attention. The insect should be killed prior to removal, using mineral oil or lidocaine (2%). EMLA cream has also been reported as being effective to kill the insect as well as provide local anaesthesia.¹

Methods of removal
- Irrigation is the simplest method of foreign body removal, provided the tympanic membrane is not perforated.² An electric ear syringe, available in some areas, may be very helpful for irrigation.³ Use of the commercial product Waterpik is not recommended because the high pressure it generates may perforate the tympanic membrane. Irrigation with water is contraindicated for soft objects, organic matter, or seeds, which may swell if exposed to water.
- Suction is sometimes a useful means of foreign body removal.² Suction the ear with a small catheter held in contact with the object. Grasp the object with alligator forceps. Place a right-angled hook behind the object and pull it out. Form a hook with a 25-gauge needle to snag and remove a large, soft object such as a pencil eraser.
- Avoid any interventions that push the object in deeper.
- The physician may need to sedate the patient to attempt removal of the object. Use mild sedation following a procedural sedation protocol.
- See Foreign Body Removal, Ear for more information.
Special instances
- Cyanoacrylate adhesives (eg, Superglue) may be removed manually within 24-48 hours once desquamation occurs. If adhesive touches the tympanic membrane, remove it carefully, and refer the patient to an ENT specialist.
- Remove batteries immediately to prevent corrosion or burns. Do not crush battery during removal.

Consultations

Consult an ENT specialist if the object cannot be removed or if tympanic membrane perforation is suspected.

Patient education

For excellent patient education resources, visit eMedicine's Ear, Nose, and Throat Center. Also, see eMedicine's patient education article Foreign Body, Ear.

Medications

After the foreign body is removed, inspect the external canal. For most foreign bodies, no medications are needed. However, if infection or abrasion is evident, fill the ear canal 5 times/day for 5-7 days with a combination antibiotic and steroid otic suspension (eg, Cortisporin or Cipro HC).

Miscellaneous

Medicolegal pitfalls

Failure to consider diagnosis when typical history is not given (eg, older patients)
Failure to prevent further damage when attempting to remove the object, especially when the object is next to the tympanic membrane
Failure to diagnose serious damage to ossicles, retained middle ear foreign body, or perilymphatic leak
Failure to diagnose bilateral foreign bodies
Failure to provide appropriate follow-up for people with chronic ear problems

References

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Davies PH, Benger JR. Foreign bodies in the nose and ear: a review of techniques for removal in the emergency department. J Accid Emerg Med. Mar 2000;17(2):91-4. [Medline].
Jones I, Moulton C. Use of an electric ear syringe in the emergency department. J Accid Emerg Med. Sep 1998;15(5):327-8. [Medline].
Backous DD, Minor LB, Niparko JK. Trauma to the external auditory canal and temporal bone. Otolaryngol Clin North Am. Oct 1996;29(5):853-66. [Medline].
Balbani AP, Sanchez TG, Butugan O, et al. Ear and nose foreign body removal in children. Int J Pediatr Otorhinolaryngol. Nov 15 1998;46(1-2):37-42. [Medline].
Goldman SA, Ankerstjerne JK, Welker KB, Chen DA. Fatal meningitis and brain abscess resulting from foreign body-induced otomastoiditis. Otolaryngol Head Neck Surg. Jan 1998;118(1):6-8. [Medline].
Hof JR, Kremer B, Manni JJ. Mould constituents in the middle ear, a hearing-aid complication. J Laryngol Otol. Jan 2000;114(1):50-2. [Medline].
Jones RL, Chavda SV, Pahor AL. Parapharyngeal abscess secondary to an external auditory meatus foreign body. J Laryngol Otol. Nov 1997;111(11):1086-7. [Medline].
Peacock WF. Otolaryngologic emergencies. In: Tintinalli JE, et al, eds. Emergency Medicine: A Comprehensive Study Guide. 4th ed. McGraw Hill Text; 1996:1068-81. [Medline].
Pfaff JA, Moore GP. Eye, ear, nose, and throat. Emerg Med Clin North Am. May 1997;15(2):327-40. [Medline].
Pons PT. Foreign bodies. In: Rosen P, et al, eds. Emergency Medicine: Concepts and Clinical Practice. Mosby-Year Book Inc; 1992:319-337.
Schulze SL, Kerschner J, Beste D. Pediatric external auditory canal foreign bodies: a review of 698 cases. Otolaryngol Head Neck Surg. Jul 2002;127(1):73-8. [Medline].
Strachan DR, Kenny H, Hope GA. The hearing-aid battery: a hazard to elderly patients. Age Ageing. Sep 1994;23(5):425-6. [Medline].
White SJ, Broner S. The use of acetone to dissolve a Styrofoam impaction of the ear. Ann Emerg Med. Mar 1994;23(3):580-2. [Medline].

Keywords

foreign objects in the ear, object in ear canal, object in ear, ear pain, hearing loss, tympanic membrane perforation, ear problems, ear foreign body, otalgia, insect in ear, bug in ear

Contributor Information and Disclosures

Author

Medical Editor

Edmond A Hooker II, MD, DrPH, FAAEM, Assistant Professor, Department of Health Services Administration, Xavier University; Associate Clinical Professor, Department of Emergency Medicine, University of Louisville; Assistant Clinical Professor, Department of Emergency Medicine, Wright State University
Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark W Fourre, MD, Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Further Reading