How are Foreign Bodies in the Ear Removed

There are many ways to remove foreign bodies from the ear. The actual method used depends on the type of the foreign body. Detailed below are the various methods and the situations in which they are used.

Patient profile

The patient is very often (but not always) a small child who has accidentally (or experimentally!) inserted something into his ear canal or has had something inserted into the ear by a sibling or peer. The child may admit to the presence of a foreign object in the ear or the parents may have spotted something in the ear. Sometimes the child presents with pain and ear discharge.

They may also be seen in adults. They don’t usually cause symptoms, but impacted foreign bodies and insects in the ear canal can be painful.

Problems with ear foreign bodies

The ear canal is quite narrow, especially in children, so foreign objects can easily get impacted within, making removal difficult. Manipulating them can be painful as the skin lining the ear canal is closely adherent to the underlying bone. Also, parents and caregivers are often tempted to try removing them as they lie deceptively close to the opening. So initial manipulation may only result in pushing the object deeper into the canal or cause pain and bleeding, making the child very anxious at the second attempt.

Methods for removal

• Syringing
• Manual removal – hook, forceps, suction
• Removal using microscope and micro instruments
• Need for GA and post aural incision

Aural syringing or irrigation

This is one of the most convenient methods to remove foreign bodies from the ear canal. Water at body temperature is sprayed into the external auditory canal from a metallic aural syringe. The stream of water goes beyond the object inside the ear canal and pushes it out.

Points to remember:

• Water used should be at body temperature, using cold water can cause giddiness.
• The water jet should not be directed towards the tympanic membrane to avoid causing perforations.
• This method will not work when the object completely occludes the external auditory meatus.
• This method is not used for vegetative foreign bodies like seeds that can swell up after absorption of water and become impacted.

Manual removal

Objects in the ear can be removed in an OPD set up using a head light or a head mirror and Bull’s lamp. They can either be hooked out using the ring curette at one end of the Jobson Horne ear probe. Or they can be removed using aural forceps. Small aural suction tips may be used to remove them with the help of suction. Remember that touching the canal wall with the instrument will cause pain.

Using a microscope

Impacted objects, objects that become fragmented when removal is attempted and objects not clearly visible with a headlight because of their depth in the canal or because the canal itself is very narrow may be safely removed using a microscope and microforceps.

Role of general anesthesia, postaural incision

Very small children, uncooperative patients and severely impacted foreign bodies may require the use of general anesthesia (or sedation) for safe removal. Objects that have entered the middle ear may be removed using the postaural incision.

Strange foreign bodies in the ear

Children usually present with seeds, beads, small parts of toys, paper and the like. Insects are common among adults. They simply walk (or fly) into the dark recess, usually at night. Cotton buds are also common, the cotton part of the bud getting left behind after a patient cleans his ears.

Button batteries and hearing aid cells are dangerous foreign bodies – they get deep into the canal and may lie close to or on the tympanic membrane. They have a corrosive action when their chemicals start to leak and cause necrosis of the surrounding tissue.

I have seen patients with garlic in their ears. Apparently people insert a clove of garlic into their ear as a home remedy for cold – a large clove will easily swell up enough to completely block the ear.

How about your experience with ear foreign bodies? Have you seen something really strange? Have you used any novel technique to remove it? Leave a comment to share with us.