A foreign object in the ear can cause pain and hearing loss. Usually you know if an object is stuck in your ear, but small children may not be aware of it.
If an object becomes lodged in the ear, follow these steps:
- Don’t probe the ear with a tool. Don’t attempt to remove the foreign object by probing with a cotton swab, matchstick or any other tool. To do so risks pushing the object farther into the ear and damaging the fragile structures of the middle ear.
- Remove the object if possible. If the object is clearly visible, pliable and can be grasped easily with tweezers, gently remove it.
- Try using gravity. Tilt the head to the affected side to try to dislodge the object.
- Try using oil for an insect.If the foreign object is an insect, tilt the person’s head so that the ear with the offending insect is upward. Try to float the insect out by pouring mineral oil, olive oil or baby oil into the ear. The oil should be warm but not hot. As you pour the oil, you can ease the entry of the oil by straightening the ear canal. Pull the earlobe gently backward and upward for an adult, backward and downward for a child. The insect should suffocate and float out in the oil bath. Don’t use oil to remove any object other than an insect. Don’t use this method for a child if ear tubes are in place or if you think the eardrum may be perforated. Signs of this are pain, bleeding or discharge from the ear.
- Try washing the object out.Use a bulb ear syringe and warm water to irrigate the object out of the canal, again provided no ear tubes are in place and you don’t suspect the eardrum is perforated.
If these methods fail or the person continues to experience pain in the ear, reduced hearing or a sensation of something lodged in the ear, seek medical assistance.
1. Remove Object if Possible
- If you can see the foreign body in the ear and remove it easily, carefully do so using tweezers. Never poke at the ear or try to remove the object by force.
- Tilt the head to try to help the object fall out.
- If it is a live insect, you can kill it for easier removal by putting a few drops of baby oil or vegetable oil in the ear. Have the person tilt and gently shake his or her head to dislodge the object. Don’t use this method for anything other than an insect, and don’t use it if there is any pain or bleeding or if the person has tubes in the ear.
- If you can’t see the object or can’t remove it easily, or if removing it will cause pain, call your health care provider.
2. Do Not Try to Remove Earwax
- If you believe earwax is causing ear discomfort or hearing loss, see ahealth care provider. Don’t use cotton swabs. They can push earwaxdeeper into the ear. Other earwax removal methods can cause ear damage.
3. When to See a Health Care Provider
See a health care provider immediately if:
- You cannot remove the foreign body easily by yourself or if parts of the object remain in the ear.
- Pain, hearing loss, or discomfort continues after the object is removed.
4. Follow Up
If the person sees a health care provider, the next steps depend on the particular case.
- The health care provider will remove the object by using tweezers, by flushing it with water, or by using another removal method.
- The health care provider may give the person antibiotic eardrops if the ear has been injured or shows signs of infection.
- If earwax is affecting hearing or causing discomfort, the health care provider may use a special tool to remove it.The removal of foreign bodies from the ear is a common procedure in the emergency department. Children older than 9 months often present with foreign bodies in the ear; at this age, the pincer grasp is fully developed, which enables children to maneuver tiny objects.
See Foreign Bodies: Curious Findings, a Critical Images slideshow, to help identify various foreign objects and determine appropriate interventions and treatment options.
In adults, insects (eg, cockroaches, moths, flies, household ants) are the foreign bodies most commonly found in the ear. Rarely, other objects have been reported (eg, teeth, hardened concrete sediments, illicit drugs, plant material).Some persons from Mexico and Central America reportedly insert leaves and other plant material into their ears as a form of native remedy. Also, some adults with psychiatric disorders present to the emergency department with foreign bodies lodged in their ears as a form of self-mutilation called ear stuffing.
In children, the range of foreign bodies is extensive. Food particles (eg, candy, vegetable matter, beans, chewing gum) and other organic material (eg, leaves, flowers, cotton pieces) are commonly encountered. Inorganic objects such as small toys, beads, pencil erasers, and rocks are also common.
The ear is composed of external, middle (tympanic) (malleus, incus, and stapes), and inner (labyrinth) (semicircular canals, vestibule, cochlea) portions. The auricle and external acoustic meatus (or external auditory canal) compose the external ear. The external ear functions to collect and amplify sound, which then gets transmitted to the middle ear. The tympanic cavity (middle ear) extends from the tympanic membrane to the oval window and contains the bony conduction elements of the malleus, incus, and stapes. The primary functionality of the middle ear is that of bony conduction of sound via transference of sound waves in the air collected by the auricle to the fluid of the inner ear. The inner ear, also called the labyrinthine cavity, is essentially formed of the membranous labyrinth encased in the bony osseus labyrinth. The labyrinthine cavity functions to conduct sound to the central nervous system as well as to assist in balance.Sometimes a young child admits to putting something like a bead or a bean in his ear, or an adult witnesses the act. Sometimes the history is hidden and the child simply presents with a purulent discharge, pain, bleeding or hearing loss. Most dramatically, a patient arrives at the emergency department panic-stricken because he feels and hears a bug crawling around in his ear.
- If there is a live insect in the patient’s ear, simply fill the canal with mineral oil (e.g., microscope immersion oil). Lay the patient on his side and drop the oil down the canal while pulling on the pinna to remove air bubbles. This will suffocate the intruder, so it can be removed using one of the techniques below. The least invasive methods should be tried first.
- Water irrigation is often effective for safely removing a foreign body that is not tightly wedged in the ear canal. This can be accomplished with an irrigation syringe, Water Pik, or a standard syringe and scalp vein needle catheter cut short (see above). Tap water or normal saline at body temperature can be used to flush out the foreign body by directing the stream along the wall of the ear canal and around the object, thereby flushing it out.
- If the object is light and moves easily, attempt to suction it out with a standard metal suction tip or specialized flexible tip, whichever can make a vacuum seal on the foreign body.
- If a hard or spherical foreign body remains in the ear canal, and the patient is able to hold still, you can attempt to roll it out with a right-angle hook, ear curette or wire loop. Stabilize the patient’s head and fix your hand against it, holding the instrument loosely between your fingers to reduce the risk of injury should the patient move suddenly. Under direct visualizaton through an ear speculum, slide the tip of the right-angle hook, ear curette or wire loop behind the object (rotate the hook to catch) and then roll or slide the foreign body out of the ear.
- Alligator forceps are best for grasing soft objects like cotton or paper. The wooden shaft of a long cotton swab can be armed with one drop of cyanoacrylate (Super Glue) to adhere to a smooth, clean, dry foreign body. Touch it to the foreign body, hold for ten seconds, then pull. Try not to glue the stick to the wall of the ear canal, but if you do, be thankful for cerumen (above).
What not to do:
- Do not use a rigid instrument to remove an object from an uncooperative patient’s ear. An unexpected movement might lead to a serious injury of the middle ear.
- Do not attempt to remove a large bug or insect without killing it first. They tend to be wily, evasive little creatures well equipped for fighting in tunnels. In the heat of battle, the patient can become terrorized by the noise and pain and the instrument that you are using is likely to damage the ear canal.
- Do not attempt to irrigate a tightly wedged bean or seed from an ear canal. The water may cause the bean to swell.
- Do not attempt to remove a large or hard object with bayonet or similar forceps. The bony canal will slowly close the forceps as they are advanced and the object will be pushed farther into the canal. Alligator forceps are designed for the canal, but even they will push a large, hard foreign body farther into the ear.
The cutaneous lining of the bony canal of the ear is very sensitive and is not much affected by topical anesthetics. If your patient is an uncooperative child, you might make one cautious attempt at removal under conscious sedation (see below) with firm head restraint, but your most prudent strategy is to schedule elective removal under general anesthesia by a specialist.Irrigation techniques and the use of the ear curette can also be effective in removing excess cerumen from an ear canal (see above). Whenever an instrument is used in an ear canal it is a good idea to warn the patient or parents beforehand that there may be a small amount of bleeding.Complications of foreign body removal include trauma to the skin of the canal, canal hematoma, otitis externa, tympanic membrane perforations, ossicular dislocations and facial nerve palsy.
- There should be no delay in removing an external auditory canal foreign body when there is an obvious infection or when the foreign body is a disk batters. On contact with most tissue, this type of alkaline battery is capable of producing a liquefactive necrosis extending into deep tissues. After removal, the canal should be irrigated to remove alkalai residue. Styrofoam beads can be instantly dissolved by spraying them with a small amount of ethyl chloride. Lidocaine has been shown to make cockroaches exit the ear canal, but this may be unpleasant for the patient. On telephone consultation, patients can be instructed to use cooking or baby oil to kill an intra-aural insect, which can then be removed in a subsequent office visit.
- What to do:
- Ear Foreign Body Causes· Insects are well known to crawl into the ear, usually when you are asleep. Sleeping on the floor or outdoors would increase the chance of this unpleasant experience.Fortunately, most people can tell if there is something in their ear. The ear canal, where most objects get stuck, is very sensitive. The ear canal ends at the eardrum, which is also highly sensitive. The symptoms of having a foreign body in the ear largely depend on the size, shape, and substance involved.· Pain is the most common symptom. If the object is blocking most of the ear canal, you may experience a decrease in hearing on that side.· Bleeding is also common, especially if the object is sharp or if you try to remove it by sticking something else into your ear.· Persistent pain, bleeding, or discharge from the ear could mean that the ear passages have not been completely cleared, part of the object could remain inside the ear, or an infection of the ear canal has developed. These infections generally respond well to antibiotic drops, but an exam and prescription are necessary.In the majority of cases, the situation of having something in your ear will not be life threatening. Usually you will have time to call your regular doctor. The urgency of the situation primarily depends on the location of the object and the substance involved.· Urgent removal is also recommended for food or plant material (such as beans) because these will swell when moistened.
- · Urgent examination is indicated if the object is causing significant pain or discomfort, or there is significant hearing decline ordizziness.
- · Button batteries commonly found in many small devices and toys can decompose enough in the body to allow the chemicals to leak out and cause a burn. Urgent removal is advised.
- · A foreign body in the ear can also damage the eardrum, which may or may not affect hearing. Because you can’t see the eardrum from the outside, an exam of the ear is recommended.
- · One of the most distressing experiences with this problem is having a live insect in the ear. The insect’s movement can cause a buzzing in the ear and may be quite uncomfortable. Fortunately, dripping mineral oilinto the affected ear will usually kill the insect. This is safe as long as you do not have a hole in your eardrum.
- · Additionally, irritation to the ear canal can also make you nauseated, which could cause you to vomit. Some people may also cough or clear their throat because of stimulation of a nerve in the ear canal that also has a branch in the throat.
- · Occasionally, a foreign body in the ear will go undetected and can cause an infection in the ear. In this situation, you may notice ongoing infectious drainage from the ear.
- Ear Foreign Body Symptoms
- · The vast majority of objects found in ears are placed there voluntarily, usually by children, for an endless variety of reasons. A caregiver should not threaten a child when asking about this possibility, because the child may deny having put something in the ear in order to avoid punishment. This denial could easily result in a delay of its discovery and increase the risk of complications.
Insects are well known to crawl into the ear, usually when you are asleep. Sleeping on the floor or outdoors would increase the chance of this unpleasant experience.
Ear Foreign Body Symptoms
Fortunately, most people can tell if there is something in their ear. The ear canal, where most objects get stuck, is very sensitive. The ear canal ends at the eardrum, which is also highly sensitive. The symptoms of having a foreign body in the ear largely depend on the size, shape, and substance involved.
- Occasionally, a foreign body in the ear will go undetected and can cause an infection in the ear. In this situation, you may notice ongoing infectious drainage from the ear.
- Pain is the most common symptom. If the object is blocking most of the ear canal, you may experience a decrease in hearing on that side.
- Additionally, irritation to the ear canal can also make you nauseated, which could cause you to vomit. Some people may also cough or clear their throat because of stimulation of a nerve in the ear canal that also has a branch in the throat.
- Bleeding is also common, especially if the object is sharp or if you try to remove it by sticking something else into your ear.
- One of the most distressing experiences with this problem is having a live insect in the ear. The insect’s movement can cause a buzzing in the ear and may be quite uncomfortable. Fortunately, dripping mineral oilinto the affected ear will usually kill the insect. This is safe as long as you do not have a hole in your eardrum.
- Persistent pain, bleeding, or discharge from the ear could mean that the ear passages have not been completely cleared, part of the object could remain inside the ear, or an infection of the ear canal has developed. These infections generally respond well to antibiotic drops, but an exam and prescription are necessary.
- A foreign body in the ear can also damage the eardrum, which may or may not affect hearing. Because you can’t see the eardrum from the outside, an exam of the ear is recommended.
In the majority of cases, the situation of having something in your ear will not be life threatening. Usually you will have time to call your regular doctor. The urgency of the situation primarily depends on the location of the object and the substance involved.
- Button batteries commonly found in many small devices and toys can decompose enough in the body to allow the chemicals to leak out and cause a burn. Urgent removal is advised.
- Urgent removal is also recommended for food or plant material (such as beans) because these will swell when moistened.
- Urgent examination is indicated if the object is causing significant pain or discomfort, or there is significant hearing decline ordizziness.
Exams and Tests
Most objects can be seen with good lighting and a few instruments.
- Occasionally, an object is discovered accidentally when X-rays are taken for unrelated reasons. It is important to realize that many materials such as food, wood, and plastic will not be visible on a routine X-ray.
- Do not hesitate to ask your doctor to examine the entire head and neck region. It is distinctly possible that the person has multiple foreign bodies in both ears and foreign objects in the nose.
- A foreign body in the ear is anything that gets stuck in your ear canal other than earwax. Foreign bodies are usually trapped in the outer ear canal. The outer ear canal, or external auditory canal, is the tube from the opening of your ear to the eardrum. Many kinds of objects can get into the ear canal. Once an object is inside, it becomes difficult to remove because of the small size of the ear canal .
- Anything that is inserted in your ear may get stuck and cause an ear foreign body. Children may put and push things into their ears during play. These things may include food, toy pieces, beads, buttons or disk batteries. Sometimes a child may put an object into the ear of another child. In adults, ear foreign bodies are usually inserted on purpose to clean, ease irritation or control bleeding. These may include paper, cotton swabs and sponge material. Ear foreign bodies may also include insects that fly or crawl into the ear canal.
Signs and symptoms
- There may be a feeling that something is in your ear. You may have ear fullness or have trouble hearing if the ear canal is blocked. Foreign bodies may also cause itching, pain, fever, redness or bleeding. Thick drainage and a foul odor may come from the affected ear. This usually happens when the object has been there for a long time and infection has set in. If the foreign body is an insect, you may feel movement or hear buzzing.
- Your doctor will take a detailed history from you, including any ear problems you may have had. It is important that your doctor knows how long the foreign body has been inside the ear. It is also important to inform your doctor if you have tried to remove the stuck object. This will give your doctor an idea of how bad the problem may be.
- With good lighting, your doctor will carefully check your ear using an otoscope. An otoscope is an instrument used to better see the inside of the ear. Your doctor may also look for other problems, such as bleeding, infection or injury. Your eardrum will also be checked for tears or holes. Your doctor may also order a hearing test.
Ear Foreign Body Treatment
It is often said that you should never put anything in your ear that is smaller than your elbow. The main reason to avoid blindly putting something into your ear is that it usually results in pushing any object deeper into the ear canal. This not only can damage the eardrum, but also make ultimate removal of the object more difficult. This is particularly true of earwax.
- Earwax is usually the consistency of toothpaste. When a Q-Tip or similar object is used to get the wax out, most of the wax is packed deeply into the ear canal. It then often hardens and is much more difficult to remove.
- The shape of the ear canal is slightly changed by pulling back on the ear’s pinna (the circular part of the ear on the side of the head). By placing the affected ear down and gently wiggling the ear pinna, you may be able to shift the object enough to cause it to fall out.
- If an object becomes lodged in the ear and this technique fails, it is usually best to have it removed by a doctor who can view the object with proper lighting and instruments.
- Having a live insect in your ear can be extremely uncomfortable. People are often desperate to get the bug to stop moving. If you do not have a known hole in your eardrum, it is usually safe to place a few drops of mineral oil into the ear. This will kill the bug and allow you to calmly and safely get to a medical office for further care.
- If you have something in your ear (or your child does), and it appears that a doctor’s visit will be necessary, avoid eating or drinking anything for 8 hours before the evaluation, if possible. Some objects require sedation for safe removal. Sedation is much safer if you have not swallowed anything for 8-12 hours before the procedure.
Treatment will largely depend on the location and object or objects involved. Do not be surprised if your doctor uses his or her own unique technique to remove an object. Years of experience often provide innovative techniques that are safe and effective.
- Commonly used techniques include applying gentle suction to the object, small forceps, or instruments that have a loop or hook at the tip.
- If the object is metallic, a long instrument may be magnetized to assist in gently pulling the object from the ear.
- Another common technique involves irrigating the ear. If the eardrum appears intact, warm water can be gently squirted past the object using a small catheter. The water will turn around at the end of the ear canal and often wash the object out.
- Any experienced professional can tell you that children typically struggle with these techniques. Struggling will decrease the likelihood of success and increase the chance for complications. Sedation of the child may be considered an option to allow calm and comfortable removal of the object, if necessary.
Treatment will depend on what type of foreign body is in your ear. Treatment may also depend on how long and how deep the foreign body is in the ear canal and may include:
- Medicines: Numbing medicine may be put on your ear before doctors try to remove the foreign body. You may be given sedative and pain medicines to help you stay comfortable, calm and relaxed. Antibiotics may also be given to help you treat or prevent an infection caused by bacteria. This may be in the form of drops placed directly on the ear. If other problems occur, such as eardrum injury, your doctor may also give you antibiotics to be taken by mouth.
- Procedures: If the object can be seen directly, removal may be done using any of the following:
- Instruments: Forceps (grasper), hook or curette (scraper) may be used to remove the foreign body.
- Irrigation: Water that is body temperature is used to force the object out of the canal. Irrigation cannot be used to take out batteries or objects that may expand when they get wet, such as seeds. This procedure also cannot be used on people with an eardrum tear.
- Suction: A machine that sucks out the object from the ear canal may be used to remove small objects. This procedure uses a small plastic tube that goes in the ear and is connected to the machine.
- Chemicals: Hydrogen peroxide or acetone may be used to melt dried glue. Acetone may also be used to remove gum or plastic foam.
- Glue: Your doctor may use a stick with glue on the end to take out the foreign body. This is done by touching the foreign body with the stick and pulling it out when the glue dries. This may not be done in patients who cannot sit still during the procedure.
- Other: Liquid, such as mineral oil, may be used if the foreign body is a live insect. This is put in the ear to kill the insect first before taking it out. Once the insect is no longer moving, it is taken out whole or in pieces using instruments.
- Surgery: You may need to have surgery if the foreign body is very deep. Surgery may also be done to treat ear damage caused by the foreign body. In some cases, foreign body removal may need to be done under general anesthesia. General anesthesia is medicine that makes you completely asleep and free from pain during the procedure