Foreign body in the ear canal: safe removal
A foreign body (an object in the ear canal, the tube from the outer ear to the eardrum) should be removed carefully, so it is not pushed deeper.
Remember
Take an ear foreign body out carefully, using good light and a technique that suits the object, and refer if removal is difficult or has failed.
Mnemonic
plan, see, limit
- p plan the method
- s see the object clearly
- l limit the attempts
Use it as a short reminder of how to approach removal of an object from the ear canal.
A foreign body in the ear is a common complaint in children. Children often do not volunteer a history, so diagnosis can be delayed, and a visible object needs removing even if nobody saw it go in. It should not be left to come out on its own, because an object left in the canal can lead to infection or injury.
The aim is to take the object out without causing more damage. The external auditory canal (the tube from the outer ear to the eardrum) is narrow, and its lining skin is thin. The tympanic membrane (the eardrum) lies at the inner end, so a slipping instrument can injure the canal, damage the drum, or wedge the object more tightly in place (impaction). The canal also swells quickly after repeated tries.
A clear view is needed before removal. Most foreign bodies are obvious on otoscopy (looking into the ear with a lit, magnifying scope called an otoscope), and a headlamp and magnifying loupes (a head-worn lamp and small magnifying glasses) improve the view further. The method should then suit the object.
Forceps (used to grasp objects) suit graspable material such as paper or cotton, but they tend to push smooth, round objects such as beads deeper, so a right-angle hook is better for those. Irrigation (flushing the ear with water) suits only small, loose objects, and it is avoided for seeds, batteries, magnets or a possibly perforated eardrum.
Refer to ENT (ear, nose and throat) rather than persisting when a few attempts fail, when the object is lodged against the drum, or when the patient cannot keep still.
Key facts
- Aim
- take the object out without pushing it deeper or injuring the canal or eardrum.
- Pain
- it is a poor guide, because an object may cause little discomfort and still cause harm.
- Forceps
- paper or an insect wing can usually be lifted out with them, but smooth, round objects such as beads tend to be pushed deeper.
- Irrigation
- flushing the ear with water suits only small, loose objects and is avoided for seeds, batteries, magnets or a possibly perforated eardrum.
- Referral
- stop and refer to ENT if a few attempts fail, because the canal swells quickly after repeated tries.
- Look elsewhere
- in children, check the other ear and the nose, because a second foreign body may be present.
Exam traps
- An object in the ear canal should be removed rather than left to work its way out, because a retained object can lead to infection or canal injury.
- Forceps are not the preferred technique for smooth, round objects such as beads, because they suit graspable material such as paper and tend to push round objects deeper.
- Antibiotic drops do not remove an object from the ear canal, because they treat infection but leave the object in place, and a physical blockage still needs taking out.
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