Foreign Body, Ear
Philip Buttaravoli MD FACEP, Stephen M. Leffler MD FACEP, in Minor Emergencies (Third Edition), 2012
What To Do
Use an otoscope to inspect the ear canal while pulling up and back on the pinna to help straighten the ear canal, thereby providing a better view.
If there is a live insect in the patient’s ear, begin by filling the canal with a liquid to kill the
insect. Mineral oil, 2% lidocaine (Xylocaine), or benzocaine/antipyrine (Auralgan) works well.
(Sterile 2% lidocaine would be most appropriate if there is a myringotomy tube in place or any other opening of the tympanic membrane [TM].)
Instruct the patient to lie on his or her side, and then drip the liquid into the canal while pulling
on the pinna and pushing on the tragus to remove air bubbles (Figure 28-1).
With a foreign body (FB) that is not too tightly wedged in the canal, and if tympanic membrane
perforation or a myringotomy tube is not present, water irrigation is a very effective removal
technique. This can be accomplished with a syringe and scalp vein needle that has been cut short (Figure 28-2).
Tap water at body temperature can be used to flush out the foreign body. Direct the stream
along the wall of the canal and around the object, thereby flushing it out (Figure 28-3).
Figure 28-2. A short, soft catheter on a 5-mL syringe is safe and very effective for irrigating a loose foreign body out of the ear canal. Note: Discard the tubing after use.
If a hard or spherical object remains tightly wedged in the canal, attempt to roll the foreign body out
by getting behind it with a right-angle nerve hook, ear curette, or wire loop. (Alternatively, a
Calgiswab can be bent into a right-angle hook and used in the same way.) Use of these tools should be done under direct vision through an ear speculum.