Overview of Ear Foreign Body Removal
Doctors who often work with children in urgent care situations commonly find foreign objects in the outer part of the ear, also known as the external auditory canal (EAC). The methods used to remove these objects can vary, as each patient and their situation is different. Some patients might need to be sedated to safely remove the object. After this, they would need to be checked for possible ear injuries or infections. In such cases, it can be helpful to send these patients to an ear, nose, and throat specialist, known as an otolaryngologist.
The EAC is the most frequent place where foreign bodies are found, especially in children. In fact, it accounts for 44% of all such cases. Other places where foreign objects might be found include the nasal passage (25% of cases), throat (23%), esophagus or food pipe (5%), and the larynx or bronchi, which are parts of our respiratory system (2%). Foreign bodies in the throat are most common in adults, making up 17% of cases.
The kinds of foreign objects typically found include beads (which are most common), pieces of paper or tissue, and popcorn kernels. These three types of objects make up over half of the cases in one study. Some studies suggest that this is more common in boys, but not all researchers agree. Certain foreign objects, like button batteries, need to be removed immediately due to the risk of releasing harmful chemicals. But, inorganic objects (those not made from living matter) generally don’t need to be removed urgently. However, if a foreign body has been in the EAC for a long time, or if the EAC is very swollen, it may make removal more difficult and painful.
Doctors need to consider several factors to successfully remove a foreign object from the ear:
– The type of material of the object.
– The characteristics of the object i.e. whether it is soft or hard, how easy it is to grasp, whether it can break apart (like an insect’s body), if it is alive or dead, and whether it is corrosive.
– The location of the object.
-The available equipment, including lights.
– The doctor’s training and skill.
– The patient’s cooperation.
The first try at removing a foreign object from the ear is usually the most successful. Doctors should always consider the possibility that there might be more than one foreign object, especially in young children. Otolaryngologists have the highest success rate of removing foreign bodies from the ear, with a success rate of 92.9%, compared to a 64.1% success rate for other health care providers.
It is often necessary to treat patients with antibiotic and steroid ear drops, especially if they have cuts or trauma to the EAC. If a patient has a ruptured eardrum or loss of hearing, they should be referred to an otolaryngologist for further checks and treatment.
Anatomy and Physiology of Ear Foreign Body Removal
The External Auditory Canal (EAC) is like a funnel delivering sound waves into the ear, important for hearing. This includes a middle section composed of the eardrum and tiny bones, bridging the gap between air and the liquid-filled inner ear.
Now, the EAC and the outer layer of the eardrum, grow from the first hollow groove on the side of a fetus’ neck, known as the 1st branchial cleft. The part closest to the middle of the ear is made of bone and is covered with skin. However, the outer part is lego-like blocks, called cartilage, and the skin there contains hairs and special sweat glands that make earwax.
The EAC is primarily served by two nerves from the brain: the third branch of the sensory nerve to the face, and the nerve that controls the heart, lungs, and digestive tract. Interestingly, a smaller nerve stemming from these can sometimes cause coughing or gagging in some people while undergoing ear procedures. Other nerves also serve the EAC, but to a lesser degree. Certain diseases that affect these nerves may lead to numbness or lesser sensitivity in parts of the EAC, called the Hitzelberger sign.
The EAC is almost straight in young children and grows to about 2.5 cm in length by age 9, which is close to the adult length. The EAC forms a gentle ‘S’ shape in adults. This shape helps improve the visibility of the eardrum. Any issues with the skin on the area of the ear made of cartilage can lead to infections or even cancerous growths.
When it comes to taking out foreign bodies from the ear or performing surgery, two naturally narrow sections in the EAC are quite significant. The first one is where the bony and cartilage portions meet, called the isthmus, and is the narrowest part. The second is closer to the eardrum.
In rare instances, the EAC has a potential blind spot in the eardrum, caused by its tilt towards a certain joint in the jaw (temporomandibular joint). Known as the Fissures of Huschke, this is important to remember when evaluating patients with ear discharge, especially when there is no visible object in the ear or ear disease.
The EAC acts like a natural amplifier for sound. The length primarily determines the resonant frequency, but its curvature doesn’t affect sound perception. However, blockages such as earwax, fluid, or foreign objects can disrupt hearing and the ability to tell where sounds are coming from.
Why do People Need Ear Foreign Body Removal
If something gets stuck in your ear, you might feel pain, notice liquid coming out of your ear, hear constant ringing or buzzing, have a spinning sensation, or experience hearing loss. When there is a suspicion that something is lodged in the ear, it’s important to remove it as quickly as possible especially if it is visible on examination.
The first attempt to remove the object should be done in optimal conditions – good lighting, using the right tools, and making sure the patient is comfortable or appropriately sedated (this might be needed if the person is too anxious or cannot hold still). There are times when it would be best to reach out to a specialist in ear, nose, and throat (also known as otolaryngology) for help. This way, the object can be safely removed at a high success rate and with minimal complications.
When a Person Should Avoid Ear Foreign Body Removal
Sometimes, specialists known as otolaryngologists (also known as ear, nose, and throat doctors) may need to remove objects stuck inside your ear. There are usually no specific reasons why otolaryngologists cannot perform this procedure, but it might be restricted by where it is being done, what equipment is available, and whether the patient needs to be put to sleep for it.
However, for doctors that are not otolaryngologists, there are specific situations where it might be risky to remove the object from the ear. These include:
– The object is difficult to grasp, tightly stuck, or very close to the eardrum.
– The object is sharp.
– Earlier attempts to remove the object were not successful.
– The patient is not able to cooperate.
– There is not enough equipment or light to safely see and remove the object.
– The object is made of a sponge-like material that could expand with moisture, making it dangerous to use water to get it out.
– The patient’s eardrum is damaged.
– There is evidence of injury to the ear canal.
– There is too much bleeding.
– There is pus or abnormal fluid coming out of the ear.
– The object is made from natural materials like food or plants.
– The object is a battery.
– There is a suspicion of a tumor or uncommon growth, such as a cholesteatoma.
Patients in these situations should see an otolaryngologist to ensure they have access to the appropriate tools and skills necessary for safe removal.
Equipment used for Ear Foreign Body Removal
There are various methods to remove foreign objects that have somehow gotten into the ear canal, also known as the Ear Canal (EAC). Which method the doctor chooses to use depends on aspects like what the object is, where it is, and how well the patient can cooperate. Key tools that doctors often use include an otoscope (a device to look into the ears), alligator forceps (a type of plier), cup forceps, hooks, Schuknecht suction tips (specially designed for ear), Rosen picks (another tool for the ear), and balloon catheters (a thin, flexible tube) such as the Fogarty catheters.
Looking through a binocular microscope is really helpful when using these tools because it provides a clear, magnified view. Therefore, it is the preferred method for ear, nose, and throat doctors (otolaryngologists).
One common approach to remove the object is irrigation. This is when they wash out the ear canal, using something like a syringe attached to an angiocatheter (a thin tube placed into a blood vessel). Alternatively, a butterfly catheter might be used. This is where they remove the needle from it and attach the remaining tubing to the syringe. However, they must use this method carefully because undetected damage to the ear drum (tympanic membrane) from the object might occur. Some experts recommend only to irrigate the ear canal if the ear drum can be fully seen and it’s confirmed to be intact.
Getting rid of the object through suction is also an effective approach. This often involves using a Frazier tip (a suction device) under a microscope. Alternatively, a combination of magnifying surgical glasses and a headlight might be enough. For metal objects, magnets can often get the job done.
Finally, a doctor might use superglue or tissue glue to take out the object. They would apply the glue on the end of an applicator, touch it to the object, then pull the object out along with the applicator. However, this method needs clinical skills, a clear vision of the object, and the patient’s cooperation.
If an ear, nose, and throat doctor is consulted for a hard-to-remove object, the next steps will depend on whether the patient needs to be sedated. Usually, these procedures are carried out in an operating theatre with the best equipment, including an otomicroscope for a detailed view of the ear.
Who is needed to perform Ear Foreign Body Removal?
Doctors can often remove something stuck in the ear canal without any help, especially if the patient can stay still. However, some patients might need more support to remain calm and hold their head correctly while the doctor works. This is especially common with children.
Local anesthesia, which is a way to numb a specific part of the body for a short time, is generally not used in these cases. This is because the nerve supply to the ear is complicated, which makes it difficult to numb effectively. The medical team may include a ear, nose, and throat doctor (otolaryngologist), an anesthesiologist (a doctor who specializes in pain management during medical procedures), nurses, and operating room staff, especially if the patient needs to be sedated (made sleepy) during the procedure. If the object has caused ear injury, the patient may need to see a hearing specialist (audiologist) or even a speech therapist afterwards.
Preparing for Ear Foreign Body Removal
Before any procedure, doctors need to conduct a thorough examination of the head and neck, including both ears and nostrils. This is done primarily to make sure that all foreign objects, if any, are spotted and addressed properly. A medical check could also identify if the patient has put something into their ear to ease discomfort such as pain or itching, which could be due to an underlying condition. If a patient is experiencing throat pain that seems to be coming from the ear, it generally means there’s no foreign object in the ear.
When examining the ear canal, doctors are expected to identify anything out of the ordinary, particularly foreign bodies. Other checks include making sure there are no prior or doctor-caused tear or scratches either in the eardrum or the ear canal. In terms of hearing, doctors use special tuning fork tests or, when available, more in-depth hearing tests (audiometry).
Before any procedure is done, certain things need to be determined. These include understanding the nature and features of the foreign body, ensuring the patient is cooperative and figuring out the best position for the patient (seated or lying down). For children, it could be helpful if they were seated on their parent’s lap, and the parent can help out by gently holding their child’s head to the side.
The final steps of the evaluation should think about whether a medical professional specializing in conditions of the ear, nose, and throat (an otolaryngologist) should be involved and if there’s a need for general anesthesia.
How is Ear Foreign Body Removal performed
Before starting any process to take out foreign objects lodged in the ear, the doctor needs to plan how many tries they are going to make – usually no more than 1 or 2. If the removal isn’t successful after the first tries, then the doctor should stop any other attempts and ask a specialist ear doctor (an otolaryngologist) to handle the situation next. The doctor should also check the child’s other ear and nose to see if there are any additional foreign bodies in there. A 2020 study found that 75% of things stuck in the ear were removed in outpatient settings or emergency departments, while around 23% required removal in an operating room under general anesthesia.
There are a bunch of different methods a doctor can use to take out foreign objects from the ear, and the method they pick is going to depend on what the object is and the specific needs of the patient. Broadly, these methods include manual extraction, flushing the ear with water, suction, using specialized glue, and, when necessary, removing bugs.
Manual extraction: Tools like tweezers, scoop-like instruments (curettes), and hooks can be used to take objects out of the ear canal. To do this, the doctor first focuses a light onto the object. They might gently pull back the outer part of your ear to better see what they’re dealing with. If they use tweezers, they grasp the object very carefully and remove it. Scoop-like instruments and hooks are carefully placed behind the object so the doctor can scoop it out effectively. There are even specialized rods with magnets on the end that can be used to remove metallic objects. When these tools are being used, it’s important to avoid touching the skin of the ear canal too much, particularly near the eardrum, because that part of the ear is very sensitive.
Flushing with water: The doctor can also flush warm water into the ear canal to get rid of the object. To do this, the doctor gently pulls the outer part of the ear back and squirts warm water upward inside the ear canal. The water should be behind the object to wash it out. The doctor needs to make sure they don’t use water that’s too hot or too cold, otherwise, it could cause dizziness or lead to feelings of nausea and vomiting.
Suction: A suction procedure is done with a special tool that creates vacuum pressure. Under direct visualization, the doctor presses the suction tip against the foreign object. A mechanism in the device creates suction, and as this pressure pulls at the object, the doctor carefully removes it.
Using specialized glue: The doctor might also use a special skin glue to remove small objects. They apply a tiny bit of the glue to a cotton-tipped applicator, shrink the size of the tip for better visibility, and carefully place the sticky end of the applicator against the foreign object. When the glue dries and firmly attaches to the object, both the object and the applicator are removed together. Throughout this process, the doctor makes sure they avoid touching the ear canal with the glue to prevent any further injury or swelling.
Removing bugs: Sometimes, bugs can crawl into people’s ears and get stuck. If this happens, the bug needs to be killed before it can be removed. Research shows that mineral oil is the best substance for killing bugs in the ear, followed by lidocaine. The chosen substance is dropped into the ear canal, after which the bug can be removed using any of the methods previously mentioned. Lidocaine has the added benefit of numbing the ear canal, which can help a patient feel more comfortable, even if the bug starts moving or scratching at the sensitive ear skin.
Possible Complications of Ear Foreign Body Removal
When a foreign object gets stuck in the ear canal, it can lead to several issues like scratches and cuts, bleeding, infections, tiny bits of the foreign object left in the ear, and even damage to the eardrum. These complications are rare, but they can occur due to attempts to remove the foreign body.
Doctors will usually conduct a test both before and after removal to document and possibly prevent any existing conditions. The area in your ear canal heals quickly when kept clean and dry. If there are cuts or bleeding in the ear canal, antibiotic and steroid ear drops may be needed. However, in many cases where the foreign object is removed without complications, additional treatments aren’t usually necessary.
It’s recommended for patients to see an ear, nose, and throat specialist, also known as an otolaryngologist, if their existing doctor is unable to remove the foreign object or isn’t comfortable with the procedure. This specialist is also recommended for patients who experience symptoms such as pain, redness, fever, and discharge from the ear after the foreign object has been removed, as some complications may emerge at a later stage.
What Else Should I Know About Ear Foreign Body Removal?
If you ever have something stuck in your ear canal, the doctors taking care of you need to be very aware of their abilities and the tools they have on hand. What’s in your ear, where it is, and your ability to stay still and cooperate will all play a part in figuring out if they should try to take it out. If it seems like removing the object isn’t doable on the initial check, they may need to send you to a specialist or a place where they can sedate you to make you more comfortable. Generally, any issues that come up during this process are minor and can be handled easily.