Clinical Pearls for Otic Foreign Body Removal

When I began working in the emergency department, I was surprised the first time I encountered a patient presenting with a case of insect-in-the-ear. Really? It just crawled in there?! Then, the scenario played itself out over and over again. Whether it's an exploring insect, a bead, or a pea that makes its way into a patient's ear canal, as a nurse practitioner you may find yourself removing otic foreign bodies from time to time. While the procedure is usually quite simple, if done improperly serious complications can result. 

Here are a few clinical pearls to keep in mind when removing foreign bodies from the ear. 

It's a Bug's Life

Insects making their way into the ear canal occurs more commonly than you might think. As an initial, non-invasive tactic, turn off the lights in the exam room and shine a light at the ear. Occasionally, the light will draw the insect out of the ear canal. If this technique is ineffective, remove the insect manually. Before attempting removal of the insect, place 2% lidocaine in the affected ear canal. This will not only provide analgesia but also kill the insect making removal easier, not to mention your patient more at ease. 

Supercharged - Considerations for Batteries

Children are inevitably drawn to placing small button batteries into bodily orifices. While many kinds of foreign objects in the ear can be safely observed for one to two weeks without complication, batteries are a different matter. Given their caustic nature, batteries must be removed immediately. Avoid irrigation in patients presenting with batteries in the ear as the electrical current created may result in liquefaction of battery contents and resulting tissue damage. 

A Disappearing Act

Got a case of styrofoam in the ear canal? Rather than putting the patient through the trauma of manual extraction, simply dissolve the offending foreign body using acetone. Acetone may also be used to dislodge superglue that is inadvertently placed in the ear canal.

Consider the Approach

Irrigation, suction, and mechanical extraction with a right angle hook or alligator forceps may all be effective methods for foreign body removal from the ear. Choose an appropriate instrument based on the type of foreign body present. Small, light and mobile objects are among those most easily removed with suction. Foreign bodies that may expand should not be removed with irrigation. 

If At First You Don't Succeed

The first attempt at removing a foreign body from the ear is critical. After a failed initial attempt, the chance of success at removal decreases dramatically. As more attempts are made to remove the foreign body, the risk of complications increases. As many as 30 percent of patients may require specialty referral, sedation, and/or anesthesia for removal of a foreign body from the ear. Complications of foreign bodies in the ear canal include damage to the tympanic membrane, ossicular damage, hearing loss, vertigo, and facial nerve damage. 

A Sticky Situation

Tissue adhesives may be considered for removal of otic foreign bodies. Simply apply tissue adhesive to the wooden end of a cotton swab and carefully insert the end into the ear canal. Take care not to touch any surface except that of the foreign body. Keep contact with the foreign body for 60 seconds then pull the cotton swab out with the foreign body attached. 

After removing a foreign body from the ear, make sure to reexamine the ear checking for signs of complications. Don't forget to perform a thorough ENT exam looking closely for additional foreign bodies in the opposite ear or nares. Most foreign bodies in the ear can be removed in the clinic or emergency department however specialist referral must be considered in situations where the patient is a risk for complications or removal has failed after multiple attempts. 

 

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