Foreign bodies in the external canal are commonly seen in the emergency department. The variations can include anything from cotton, pencil erasers, or pieces of toys to illicit drugs and insects. Organic materials such as beans, seeds, and vegetable matter may conform to the contour of the canal or expand if moistened, complicating the dilemma of removal. Insects that crawl into the ear can actually survive for a long period of time, causing a local inflammation and a great deal of distress to the patient.
The evaluation of a patient with a foreign body in the ear should begin with calming the patient and placing him or her in the reclined position. Occasionally the complaint may be sudden pain while in the recumbent position, as in the case of an embedded insect. Most of the time, the history will reveal the type of material in the ear. A thorough examination and visualization of the complete tympanic membrane is mandatory. Inability to visualize the entire canal, contact of the foreign body with the tympanic membrane, or the presence of a perforation mandates the use of an operative microscope and speculum, with obvious consultation. Foreign bodies in children medial to the bony isthmus often require conscious sedation or even general anesthesia for safe extraction. 29 Cerumen loops, a right-angle hook, and alligator forceps are the instruments of choice for the removal. Live objects should be drowned with a 2% lidocaine solution or viscous lidocaine, which immediately paralyzes the bug and provides modest topical anesthesia to the cutaneous area. The liquid can then be suctioned out with butterfly tubing and the insect removed with gentle suction or forceps under direct visualization. Care must be taken to assure that no debris of the insect remains in the canal. Irrigation with room-temperature water is adequate for small particles such as hard sand or cerumen and can mobilize distally positioned objects. Irrigation should not be used unless the tympanic membrane is completely visualized and free of perforation, and it can be utilized only for nonorganic matter, which will not expand when moistened.
Complete inspection of the ear canal after removal of the foreign body is important to exclude more significant injury to the canal skin, tympanic membrane, and ossicles caused by the foreign body or its extraction. Small abrasions heal spontaneously. Topical antibiotics should be considered in cases where there was more serious cutaneous damage or where the foreign body consisted of organic material (see T.a.bJ.®,2.31i6.).2,9
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