Ear

Ear Canal Foreign Body

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Ear Canal Foreign Body, Ear Foreign Body, Auditory Canal Foreign Body

  • See Also
  1. Nasal Foreign Body
  2. Airway Foreign Body
  3. Esophageal Foreign Body
  • Epidemiology
  1. Most common in children (esp. age <8 years, males, right ear)
  • Causes
  1. Insects
  2. Plastic toys or beads
  3. Cotton, paper
  4. Pebbles
  5. Earing parts
  6. Organic material such as popcorn kernals or vegetable material
    1. Higher risk of infection
  7. Small batteries (may be caustic!, especially button batteries)
    1. Require removal without delay
  • Symptoms
  1. Often asymptomatic
  2. Ear Pain or fullness
  3. Ear Pruritus
  4. Decreased Hearing acuity
  5. Otorrhea or bleeding
  • Exam
  1. Otoscopy
    1. Identify foreign body type, location, graspable parts
    2. Evaluate for complete Occlusion or absorbent objects (contraindicates irrigation)
    3. Evaluate for associated injury to Tympanic Membrane, Ossicles, or canal
  2. Evaluate for other foreign bodies
    1. Contralateral ear
    2. Nares
  • Precautions
  1. Removal risks Tympanic Membrane injury or ear canal Laceration
  2. First attempts at removal are most likely to succeed
    1. Best succes is for graspable objects (e.g. paper)
  3. Risk of ear canal injury and further impaction of foreign body increases with repeat attempts
  • Management
  1. Conscious Sedation may be needed in young children
  2. Insects
    1. Live Insects may be stimulated to crawl out of the ear canal
      1. Hydrogen Peroxide installation OR
      2. Darken the room and illuminate only the external auditory canal
    2. Kill any live Insects before attempting removal
      1. Rubbing Alcohol or
      2. Lidocaine 2% or
      3. Mineral Oil
  3. Instruments and Methods
    1. Removal under direct visualization
      1. Use otoscope with operative otoscope head (allows a larger channel for instrumentation)
      2. Micro Alligator Forceps: Remove graspable foreign body
      3. More difficult if round, smooth object, in canal for >24 hours, or adjacent to Tympanic Membrane
    2. Cerumen curettes
      1. The small blue plastic Ear Curettes with its narrow caliber may more easily pass behind the foreign body
      2. Plastic curettes are maleable and the end may be bent to catch the backside of the foreign body
    3. Ear Irrigation
      1. See Ear Irrigation
      2. Do not use in Button Battery foreign body
        1. Caustic, alkaline materials will leach out of the battery when wet
      3. Do not use if organic foreign body or other absorbent material
        1. Organic objects that absorb water (e.g. beens) will swell with irrigation, making removal difficult
      4. Other contraindications to irrigation
        1. Complete foreign body Occlusion of the canal
        2. Tympanostomy Tubes or Tympanic Membrane Perforation
    4. Katz Extractor
      1. http://www.inhealth.com/category_s/49.htm
    5. Suction catheter
      1. Exercise caution due to risk of Tympanic Membrane Rupture and ossicle damage
      2. Typically defer Ear Suction to otolaryngology
      3. Use a small catheter tip (e.g. dental suction, "little sucker" pediatric suction tip or Fraser Suction Catheter)
      4. Use the lowest effective suction strength
    6. Tissue Adhesive technique (using Dermabond or cyanoacrylate)
      1. Indicated for dry, hard, non-organic foreign bodies
      2. Apply a drop of Tissue Adhesive to the wooden end of a cotton applicator (e.g. similar to q-tip)
      3. Under direct visualization, apply the freshly glued, wooden tip to the foreign body
      4. Hold the applicator tip against the surface of the foreign body for 30 seconds
      5. Carefully withdraw both the applicator and the foreign body as a unit from the ear canal
      6. Dried Tissue Adhesive may be removed with acetone or 3% Hydrogen Peroxide
      7. Lin in Herbert (2015) EM:Rap 15(2): 6-7
  4. Other measures
    1. Acetone dissolves styrofoam and Tissue Adhesive or super glue
    2. Otic Antibiotic drops are indicated for concurrent Otitis Externa or ear canal Trauma
  • Management
  • Referral
  1. Most foreign bodies may be safely deferred to ENT for removal in 1-2 days
    1. Batteries (esp. button batteries) and magnets should be removed emergently (local necrosis risk)
  2. Referral Indications
    1. Young or developmentally delayed patients requiring Conscious Sedation
    2. Ear canal Lacerations, Tympanic Membrane injury or other Trauma on attempted removal
    3. Foreign body refractory to removal attempts (e.g. impacted in canal, posterior or hidden)
    4. Sharp, penetrating or hooked foreign body
  • References
  1. Claudius and Brown (2017) Crit Dec Emerg Med 31(12): 13-20
  2. Claudius, Behar and Stoner in Herbert (2015) EM:Rap 15(11):2-3
  3. Ansley (1998) Pediatrics 101: 638-41 [PubMed]
  4. DiMuzio (2002) Otol Neurotal 23:473-5 [PubMed]
  5. Heim (2007) Am Fam Physician 76: 1185-9 [PubMed]
  6. Wilson (2025) Am Fam Physician 112(1): 27-33 [PubMed]