# Foreign Body Removal- Ear

## Overview

This module describes how to remove a foreign body from the external auditory canal.

## Indications

1. Soft foreign bodies impacted at the

   isthmus
   isthmus

   The isthmus is the narrowest part of the ear canal, where cartilage gives way to bone.

   — grasp/irrigate

2. Small foreign bodies medial to the isthmus — irrigate

3. Button batteries require

   urgent referral
   urgent referral

   Delayed referral may result in ear canal stenosis, tympanic membrane perforation and hearing loss

   to an ENT specialist

## Contraindications

1. Uncooperative patient

2. Hard foreign body impacted at the isthmus

3. Large object close to the tympanic membrane

4. Lack of appropriate tools

5. Poor visibility of the foreign body

## Patient information & consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“There is something stuck in your ear canal and I need to remove it, because it can cause infection and damage to the tissues in your ear.”

### What can my patient expect?

“Depending on what the object is, I will try to flush it out using water; however, some objects swell up in water, so I will insert an instrument behind it and hook it. This will be uncomfortable, but not painful.”

### What is my patient’s role?

“Describe exactly what the object is, as this will help me know how to remove it. Please try to remain very still during this procedure.”

## Preparation

Evaluate the patient’s external auditory canal and tympanic membrane, and enquire about the patient’s ear

health

health

Patients may insert objects into their ear in an attempt to relieve their symptoms.

(otorrhoea, otalgia or hearing loss), indicating possible perforated membrane or concurrent pathology and referral to ENT.

If the foreign body is a bug, kill it first by

instilling

instilling

If you know that the tympanic membrane is perforated, do not instil anything into the ear.

lignocaine, alcohol, or mineral oil into the ear canal. The patient may be distressed, anxious and unable to cooperate.

###

### Documentation

1. Patient notes

### Equipment

The type of equipment will vary depending on the

type of foreign body

type of foreign body

Graspable foreign bodies are foam, rubber, paper and vegetable material. Non-graspable foreign bodies are beads, pebbles and popcorn kernels.

, the patient’s cooperation and where it is located.

1. Alcohol-based hand rub

2. Otoscope, ideally with operating head

3. Crocodile forceps

4. Curette, right-angle hook or Jobson Horne probe

5. Equipment for ear irrigation

6. Wall suction, suction catheter, and scissors/blade

7. Superglue and a cotton-tipped applicator

## Site & Positioning

Cooperative patients can either sit or lie down with the affected ear turned towards the provider.

For small children, let an assistant or parent hold the child. Wrap the child in a sheet and sit them upright, facing you on the parent’s lap with the child’s legs restrained by the parent’s crossed legs. The parent holds the child’s body with one arm, and the child’s forehead with the other. Rest the back of the child’s head against the parent’s body.

## Procedure

Follow medical asepsis without gloves.

1. Perform hand hygiene.

2. Irrigate the ear to

   attempt to expel
   attempt to expel

   Don't irrigate if the foreign body will swell in water, such as beans or in the case of button batteries, where the liquefaction can cause tissue necrosis.

   the foreign body.

3. Retract the pinna and visualise the foreign object.

4. If crocodile forceps are suitable: grasp the foreign body and remove it.

5. If a curette or right angle hook is suitable: gently manoeuvre it behind the foreign body and rotate it, so the end is behind the object, and pull the foreign body out.

6. If a Jobson Horne probe is suitable: insert the probe under the foreign body, then lift the tip by depressing the outer end of the probe. Gently lever or roll out the foreign body.

7. Alternatively: cut a large rubber catheter at right angles to the tip. Use the catheter attached to gentle

   wall suction
   wall suction

   If wall suction is not available, use the bulb of a sphygmomanometer or a pneumatic otoscope.

   to remove the foreign body. Pinch the catheter closed until the tip is near the foreign body.

8. Alternatively: place a dot of superglue on the back of a cotton-tipped applicator. Touch the applicator to the foreign object and allow the glue to harden before gently withdrawing the applicator.

9. Examine the patient’s ear canal and tympanic membrane once more.

10. Dispose of medical waste safely.

11. Document the completion of the procedure and your findings in patient notes.

## Troubleshooting

I do not have a right angle hook/curette/Jobson Horne probe.

If the foreign body is hard and spherical, do not attempt to grasp it with the forceps, risking pushing it further into the ear canal. If you are unable to syringe it out because of the risk of swelling of the object, refer the patient to ENT.

I am unable to grasp the object, or remove it by hooking or syringing.

The foreign body may be stuck, embedded in thick wax, or touching the tympanic membrane. Refer the patient to ENT.

Attempted removal is very painful.

The foreign body may be sharp, or the tympanic membrane or ear canal may be damaged. Refer the patient to ENT.

The foreign body is styrofoam or superglue.

Use acetone to dissolve the styrofoam or loosen cyanoacrylate (superglue). Note that this should not be done when the tympanic membrane is perforated. If unsure, rather refer to ENT.

## Risks

1. Excoriations or lacerations of the ear canal

2. Tympanic membrane perforation

3. Ossicular chain damage

## References

1. Lotterman S, Sohal M. Ear foreign body removal. [Updated 2021 July 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459136/

2. Heim S, Maughan K. Foreign bodies in the ear, nose and throat. Am Fam Physician. 2007 Oct 15;76(8):1185-1189. Available from: https://www.aafp.org/afp/2007/1015/p1185.html

3. Kenny P. How to remove a foreign body from the ear canal. In: Mash B, Blitz-Lindeque J, eds. South African Family Practice Manual. 2nd ed. Pretoria: Van Schaik Publishers; 2010:141